Rising Acuities: The Evolution of Emergency Medicine

By Ronald W. Stunz, MD, FACEP

Based on a recent flurry of published assertions, emergency department (ED) documentation and billing have come into scrutiny as many institutions claim the use of Electronic Health Records (EHRs) has contributed to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services. In a recent article in the New York Times titled, “Medicare Bills Rise as Records Turn Electric,” it is stated that “the most aggressive billing — by just 1,700 of the more than 440,000 doctors in the country — cost Medicare as much as $100 million in 2010 alone, federal regulators said in a recent report, noting that the largest share of those doctors specialized in family practice, internal medicine and emergency care.” (1) Also noted in the same article was the fact that higher coding has captured the attention of federal and state regulators and private insurers like Aetna and Cigna, and the Office of Inspector General for the federal Health and Human Services Department warned that the coding of evaluation services had been “vulnerable to fraud and abuse.” (1) Additionally, higher acuities will be the subject of scrutiny on the part of Recovery Audit Contractors (RACs) who will start complex, or chart by chart reviews of higher levels of service. In fact, RACs have announced the starting point – the highest level of coding for office visits (99215) for primary care physicians, which will also certainly extend to EDs.

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(1) Reed Abelson, Julie Cresswell, Griff Palmer (21 September, 2012) The New York Times – “Medicare Bills Rise as Records Turn Electronic.”