Fraud-Wary Feds to Regulate EHR Copy-and-Paste Function

By Robert Lowes for Medscape Medical News

The Centers for Medicare & Medicaid Services (CMS) is going to regulate the controversial copy-and-paste capability of electronic health record (EHR) systems in its campaign against billing fraud.

CMS made its intentions known in response to a report released online today by the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS). In a survey of 864 hospitals, OIG found that only one fourth had policies governing the use of EHR copy-and-paste functions. And only 44% had EHR audit logs that record the method of data entry, whether it is copy-and-paste, voice recognition, or keyboarding.

OIG said that the ability to “clone” chart notes from a previous patient encounter to help document the next one can help physicians work more efficiently, but also invite fraud, especially if no one edits the cloned information to make sure it’s accurate and up to date. Government officials are worried that many physicians bill for higher levels of evaluation and management (E/M) services than warranted by cloning dense blocks of old patient information. For example, a physician may bring forward a diagnosis from an earlier visit — an infection, for example — that no longer applies.

In its report, OIG recommended that CMS work with hospitals and the Office of the National Coordinator for Health Information Technology (ONC) within HHS to develop guidelines for using copy-and-paste. In particular, OIG said, CMS should consider whether the risks of some practice — such as copy-pasting identical text into multiple patient charts — outweigh the benefits.

In response to the OIG report, CMS said it will develop guidelines to ensure that copy-and-paste “is used appropriately.” It noted that it intends to work with ONC to develop “a comprehensive plan to detect and reduce fraud in EHRs.”

A crackdown on EHR abuses has been long in coming. HHS Secretary Kathleen Sebelius and US Attorney General Eric Holder warned the American Hospital Association, 3 other hospital groups, and the Association of American Medical Colleges in a letter last year that healthcare providers who commit billing fraud with EHRs will be prosecuted. In addition, a number of insurance companies that process Medicare claims on behalf of CMS have said that they will reject physician claims if they are based on cloned medical documentation.

The OIG report suggests that many hospitals may have a hard time controlling the use of copy-and-paste. Roughly half of the hospitals surveyed said that they are unable to disable, restrict, or otherwise customize the copy-and-paste function of their EHR systems. EHR vendors interviewed by OIG said the same thing.

The report is available on the HHS Web site.

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