Clinicians: Copy-and-paste in EMR is not by definition fraudulent

The copy-and-paste and other functions in EHRs can make it easier to commit fraud when used inappropriately, but they're not fraudulent by default, according to a viewpoint article in JAMA Internal Medicine.

The article, written by clinicians from the University of Wisconsin School of Medicine and Public Health and the University of Wisconsin Hospital and Clinics, notes that "it is too easy, and often mistaken, to equate a physician's routine use of copy-and-paste with fraud. Data replication is a feature of electronic health records; facts beyond the mere use of duplicated text are required to establish that a note may be fraudulent."

The authors also pointed out that while copy-and-paste is related to upcoding and over documentation, it can be efficient and clinically useful when used properly, and that EHRs are "not to blame for the carelessness of individual physicians."

They recommended several solutions to reduce inappropriate use, such as the creation of hospital policies to remind physicians and other clinicians that they are legally responsible for the accuracy of the EHR note and encourage and permit documentation and billing needed to support the care that patients actually need, which may entail training, use of audit logs and review.

The authors also suggested to CMS that when it issues guidance to hospitals and their auditors about the use of the copy-and-paste function it should focus more on facilitating the responsible use of EHRs, not "overzealous auditing" which could impede the adoption of EHRs.  

EHR functionalities have come under increased scrutiny by CMS and HHS' Office of Inspector General (OIG) to ensure that they don't lead to improper billing.

The OIG reported earlier this year that CMS has provided its contractors with only limited guidance on EHR fraud and raised concerns that the contractors could not identify copied and over documented information in an EHR. The agency also found that only a quarter of hospitals studied had policies on the use of the EHR copy and paste feature to reduce the risk of billing fraud, and recommended that CMS develop guidance on the use of the copy-paste feature in EHR technology.

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- here's the viewpoint preview

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