'Targeted' EHR upcoding audits on the way

Share this content:

The Centers for Medicare & Medicaid Services will undertake targeted audits focused on upcoding in electronic health records, according to Acting CMS Administrator Marilyn Tavenner. 

Speaking at the Federation of American Hospitals conference in Washington, D.C., in early March, Tavenner said providers can expect CMS to undertake “small, targeted audits” to address upcoding.

Tavenner specifically linked physicians' offices and emergency rooms to a rise in upcoding, but long-term care providers also have been cited for upcoding by federal watchdogs. 

Skilled nursing facilities overcharge Medicare about $1.5 billion annually, with therapy-related upcoding a major factor, the Department of Health and Human Services Office of Inspector General claimed in a 2012 report. 

Yet data sharing enabled by electronic recordkeeping is driving the success of multipayer groups that include hospitals and skilled nursing facilities, Director of the Center for Medicare Jonathan Blum told a Senate committee on Feb. 28. And CMS remains committed to electronic health records, Tavenner told the hospital executives.