Attribution of NP work to docs in EHRs increases improper billing risks

States may be expanding the role of nurse practitioners to ease the looming physician shortage, but electronic health record documentation habits and other actions may impede the ability to utilize them fully, as well as lead to faulty EHR billing, according to a recently published study in the Journal of Professional Nursing.

For the study, researchers from the Columbia University School of Nursing interviewed NPs in Massachusetts, a state that recognizes NPs as primary care providers. However, most healthcare organizations listed a physician--not the treating NP--as the provider of record in the EHR because Medicare pays about 15 percent more for services billed by a physician, according to Lusine Poghosyan, leader of the research team.

In addition to the legal implications--flaws in EHR documentation could lead to fraud--the researchers found that listing the physician in the record led to the NP "invisibility," making it harder for the NPs to access patient information and track quality measures in a timely manner.

Other cultural and operational biases also hindered NPs' work, such as not allowing them to conduct physical assessments and keeping them out of the decision making process.

"Legislation is a needed to create the legal framework for nurse practitioners to practice as independent primary care providers. It's a good first step," Poghosyan said, according to an announcement. "Healthcare organizations now need to be proactive in creating policies and practices conducive to NP practice."

The integrity of EHRs will be one of the U.S. Department of Health & Human Services Office of Inspector General's highest priorities in 2014 and beyond, according to the OIG's latest Strategic Plan. The plan identifies EHRs as one of the OIG's "key focus areas" until at least 2018. OIG's 2013 work plan also focused on EHR-induced fraud. 

To learn more:
- here's the study's abstract
- check out the Columbia University School of Nursing announcement