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AHA presses HHS, DOJ for electronic billing guidance

November 13, 2012


The AHA yesterday in a letter to the departments of Health and Human Services and Justice reiterated the important role of electronic health records and the hospital field's commitment to combating fraud and abuse while calling for further guidance. The letter, the second in response to the departments' Sept. 24 letter stating that trends in increased levels of severity for emergency department coding suggest that some providers may be using automated tools to inappropriately increase their Medicare reimbursements, highlights three areas where AHA believes "additional discussions and cooperative actions would lead to greater mutual understanding of the rules and how they are enforced": development of national guidelines for hospital coding of evaluation and management services provided in clinics and emergency departments; greater understanding of functionalities that vendors embed into EHRs and other automated tools used by hospitals; and further discussion of law enforcement concerns, with the goal of jointly developing compliance guidance for hospitals. "Hospitals share the administration's goal of a health system that offers high-quality, affordable care and work hard to ensure billing is correct the first time," said AHA President and CEO Rich Umbdenstock. "Working together, we can undertake a set of activities to provide national guidelines for E/M coding by hospitals, create greater certainty that products sold by the vendors of EHRs and other automated tools promote compliance with those guidelines, and develop meaningful guidance on compliance."