AHA still pushes for national guidance on EHR billing

The American Hospital Association (AHA) this week wrote a letter to the editor, responding to a Sept. 26 New York Times article about the "abuse of electronic health records."

The NYT piece detailed the Obama administration's recent staunch warning to five provider groups--the American Hospital Association, Association of Academic Health Centers, Association of American Medical Colleges, Federation of American Hospitals and National Association of Public Hospitals and Health Systems--in which HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder said they wouldn't tolerate healthcare fraud related to EHRs. The administration last month said there's increasing evidence that providers are gaming the system by upcoding and cloning records.

AHA said it supports the newspaper's call for revised billing guidance to prevent the so-called EHR abuse.

The hospital trade group, which represents 5,000 members, stressed in the NYT op-ed, as it has repeatedly, that billing mistakes aren't equivalent to healthcare fraud.

"Government payment rules are highly complex," AHA wrote. "In recent years, the government has drastically increased the number of auditors of hospital payments. No one questions the need to identify billing mistakes, but the flood of new auditors is deluging hospitals with redundant audits, unmanageable medical record requests and inappropriate payment denials."

AHA has requested national guidelines from CMS 11 times.

Hospitals could face increased scrutiny for their billing under a 2013 work plan released this week from the Office of Inspector General, the agency charged with monitoring healthcare fraud and program integrity. The plan suggested OIG will extensively review claims for inpatient Medicare patients, transfers and canceled surgeries, among other targeted areas.

For more information:
- read the AHA letter in the NYT
- read the NYT article