Report highlights physicians’ reluctance to use automated evaluation and management services

According to a report published by the Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG), many physicians are reluctant to use their medical informatics systems for evaluation and management (EM) processes.

The survey, which polled more than 2,000 physicians, revealed that while many doctors use the EM services in their clinical informatics system, few took advantage of the automated coding features in their electronic health records (EHRs) to do so.

Approximately 90 percent of participants polled indicated they used a medical informatics system to bill Medicare for treatment administered to patients. However, none of them said they used the automated billing features of their EHR, with almost all respondents preferring to enter billing codes manually. Of those who did not perform EM billing themselves, 12 percent had other personnel enter the codes on their behalf.

The report indicates that much work remains to be done in improving the automated billing functions of medical informatics systems. Officials at the HHS have yet to implement firm guidelines on best practices relating to the use of EHRs for automated EM billing purposes.

This aspect of medical billing is particularly susceptible to fraud. A separate report published by the OIG earlier this year revealed that Medicare payments for EM services increased more than 48 percent during the past decade.

According to the report, the average Medicare payment for EM services rose by almost one-third during this period, from $65 to $85. The authors of the study speculated that some physicians are billing Medicare incorrectly for services that are covered by lower-level codes.

“Physicians are responsible for billing the appropriate EM code to Medicare,” reads the report. “It is inappropriate for a physician to bill a higher level, more expensive code when a lower level, less expensive code is warranted.”

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