{"id":475,"date":"2012-09-21T10:52:52","date_gmt":"2012-09-21T10:52:52","guid":{"rendered":"https:\/\/www.billingparadise.com\/blog\/?p=475"},"modified":"2026-03-12T08:55:23","modified_gmt":"2026-03-12T13:55:23","slug":"emr-ehr-in-un-ethical-medical-coding-practices","status":"publish","type":"post","link":"https:\/\/www.billingparadise.com\/blog\/emr-ehr-in-un-ethical-medical-coding-practices\/","title":{"rendered":"Medicare Fraud- $11billion Gone on Unethical Coding Practices"},"content":{"rendered":"

Of late there have been increasingly alarming statements emanating from the offices of CMS about seemingly blatant Medicare frauds.\u00a0 \u201cNearly 50% of the claims submitted to Medicare in certain states are fraudulent and contain upcoding\u201d.\u00a0 \u201c$11 billion has been lost by the Medicare coffers in the past decade due to unethical coding practices<\/strong>\u201d.\u00a0 Or the rather disturbing \u201cA push towards electronic medical records is causing the higher-paying codes to be used\u201d.\u00a0\u00a0 What really is the ground reality here?\u00a0 Are things really this bad when it comes to medical billing and medical coding.\u00a0 Is the push towards EMRs\/EHRs<\/a> really encouraging malpractice tendencies on the part of physicians\/clinics?<\/span><\/p>\n

Although various pro-physician bodies, including the AMA, have suggested a possible increasing complexity of the patient base as the reason for the steep usage of the larger-paying E&M codes, many present and past officials of CMS fail to buy the argument.\u00a0 \u00a0Analysis of the data collected by bodies such as Center for Public Integrity and Centers for Disease Control fail to find any average increase in patient age nor greater physician time being expended to explain the upcoding.\u00a0 Thus CMS is pretty positive that many clinics, either knowingly or unknowingly, are exploiting the so-called loopholes that would be inherent in any behemoth of a system, processing more than 350 million claims a year.<\/p>\n

Also, it has been pointed out by some CMS experts that medical billing via certain EMRs is actually encouraging the physicians\/clinics<\/span> to use the higher-reimbursing codes, since some EMR vendors do promise \u201can optimal choice of codes\u201d, picked automatically by the system in order to increase bottom lines.\u00a0 To counter all of the above, Medicare is placing increasing stress on RAC audits<\/a><\/span>.\u00a0 Even though the costs Vs benefits analysis of such audits increasingly point to a net gain of almost nothing monetarily, Medicare might actually intensify the frequencies of the audits to root out what it considers practices running counter to the principles of the Hippocratic oath.<\/p>\n

To know more about where your clinic stands when it comes to RAC audits, and to decide on a federally compliant Medical Billing<\/span><\/span><\/a> software, call us BillingParadise<\/span>, <\/span>on the toll-free at 1-(888)-571-9069 <\/em>or email steve@billingparadise.com<\/span>.<\/span><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

Of late there have been increasingly alarming statements emanating from the offices of CMS about seemingly blatant Medicare frauds.\u00a0 \u201cNearly 50% of the claims submitted to Medicare in certain states are fraudulent and contain upcoding\u201d.\u00a0 \u201c$11 billion has been lost by the Medicare coffers in the past decade due to unethical coding practices\u201d.\u00a0 Or the […]<\/p>\n","protected":false},"author":2,"featured_media":512,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[743,719],"tags":[],"class_list":["post-475","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-practice-management","category-software"],"_links":{"self":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/475","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/comments?post=475"}],"version-history":[{"count":1,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/475\/revisions"}],"predecessor-version":[{"id":450461,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/475\/revisions\/450461"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/media\/512"}],"wp:attachment":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/media?parent=475"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/categories?post=475"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/tags?post=475"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}