Article - August 10, 2007 - Government Health IT

Report: EMRs should have anti-fraud features

BY Nancy Ferris

A contractor is recommending that the Health and Human Services Department beef up its anti-fraud efforts with respect to health information technology and medical billing.

The contractor, RTI International, delivered to HHS’ Office of the National Coordinator for Health IT a report listing 14 kinds of features that should be built into electronic medical records to prevent fraudulent billing and help spot fraud once bills have been transmitted for payment.

Of the 14 recommended features, nearly one-quarter already are being required for certification by the Certification Commission for Health IT, an HHS-sponsored organization that reviews EMR products to determine whether their functionality, interoperability and security meet certain standards.

One-third of the recommended features are not being implemented yet, and 45 percent “had some foundation in the current or planned criteria, but would require additions or modifications to support an active stance against fraud” in EMRs, according to the report, “Recommended Requirements for Enhancing Data Quality in Electronic Health Records.”

The report also recommends that controlling fraud should be one of ONCHIT’s strategic objectives as it develops the Nationwide Health Information Network and encourages health providers to use interoperable EMRs.

ONCHIT should have employees whose job is to work on fraud issues and push for adoption of anti-fraud features in EMRs, RTI states.

“By and large, clinicians are not engaged in fraudulent activities,” the report states. “Not all improper payments are the result of fraud, and not all unusual billing patterns are fraudulent. However, certain documentation practices, such as data errors, mistakes in coding and confusion regarding billing codes and procedures may result in improper payments. The recommended requirements are aimed equally at reducing such erroneous documentation practices, preventing improper payments, and improving supporting documentation for legitimate claims submissions.”

"If adopted, these recommendations will strengthen current standards and provide new efficiencies to clinicians who use electronic health records in their practices," said Dr. Robert Kolodner, the national health IT coordinator, said in statement RTI issued.

The 14 recommended features of EMRs are in the following areas:

• Audit functions and features.
• Provider identification.
• User access authorization.
• Documentation process issues.
• Evaluation and management coding.
• Proxy authorship.
• Record modification after signature.
• Auditor access to patient records.
• Traceability of records.
• Patient involvement in anti-fraud.
• Patient identity proofing.
• Structured and coded data.
• Integrity of records transmission.
• Accurate linkage of claims to clinical record.