Why EHR is Costing Providers Money

EHR can cost providers a lot more money than they realize.  Of course there is the obvious, the cost of the EHR program, but it actually can go much deeper than that.

Many smaller providers have opted not to use an EHR program because they either don’t want the expense of the program or they just don’t want to be bothered.  For example, a small chiropractor may figure that it is more of a hassle to use an EHR program than to just take the penalty for not using one.  Many providers think that EHR programs are too expensive to warrant the cost.  They don’t realize that there are inexpensive programs and actually free programs available.

Currently eligible professionals, or EPs that are not demonstrating meaningful use are penalized by Medicare.  The penalty for 2016 services is 2%.  It will go up to 3% in 2017.  So if an EP is not using an EHR program they are receiving less pay for services to a Medicare patient.

If they do use an EHR program and they demonstrate meaningful use then they are not being hit with the penalty.  But they have the added cost of the program plus the costs associated with using the program.  For some providers there is no additional cost but for others there is more time involved with using the EHR program.

But there is another way that EHR programs are causing some providers to lose money.  Many EHR companies tell providers that their program does the billing for them so they no longer need a biller or an outside billing service.  Some actually offer billing services for a small additional cost which is usually much less than they are paying for their current billing.  The problem is that even though these programs have detailed claim scrubbers (software that checks for errors) and makes it so that errors are almost eliminated, that doesn’t replace the need for a biller.

Even with the added checking systems there are still issues that need to be dealt with.  The program doesn’t correct mistakes such as invalid ID number.  It is not uncommon for a patient to forget to give updated insurance information, or for that information to not be entered into the system.  The system (or clearinghouse) will reject the claim but a human will have to go in to see what went wrong, correct the information, and possibly contact the patient.

Medical billers do much more than simply enter data into a computer.  They also analyze the data going in.  Auto-posting of ERAs is a great feature.  It is a huge time saver to have the payment information automatically entered into a system.  But that information still needs to be looked over.  For example, if a claim is entered for an office visit and an EKG and the ERA comes in with payment for the office visit but not for the EKG the system may simply write off the EKG since it was not paid.  But it’s possible that the EKG was not billed properly.  If the office visit was for pre-operative clearance for knee replacement surgery and the primary diagnosis for the EKG was knee pain then the EKG may be denied.  But a biller may look deeper at the visit and see that the provider did the EKG because the patient has atrial fibrillation or coronary artery disease.  The primary diagnosis for the EKG should have been the atrial fibrillation or coronary artery disease, not knee pain.  If it had been coded that way the EKG may have been allowed separately from the office visit.

The point is that computer software can be a great tool in assisting with the billing process but it doesn’t replace the biller.  There are still many tasks that require a human.  Even if all claims are submitted 100% correct, insurance carriers may not process them correctly.  When claims are rejected incorrectly they need to be resubmitted and/or appealed.  Sometimes adjustment requests must be made.  All of these tasks must be done by a human.

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