I said it before and I will say it again, the EMR has been the biggest detriment to the practice of medicine in my lifetime. The entire idea of chasing metrics in a pay for performance paradigm diluted patient care. The physician was forever chasing the carrot on the stick to increase his bonus which, in turn, reduced the time with the p…
I said it before and I will say it again, the EMR has been the biggest detriment to the practice of medicine in my lifetime. The entire idea of chasing metrics in a pay for performance paradigm diluted patient care. The physician was forever chasing the carrot on the stick to increase his bonus which, in turn, reduced the time with the patient to actually treat the problem. The time spent in the doctor-patient encounter became skewed toward answering screening metrics as opposed to problem solving. EM coding was a contrivance to compensate for time spent with the patient, but it too has become tedious and not very helpful. Can anyone in practice really tell the difference from a 99213 visit to a 99214 or 99215 visit? In my mind the hair was so thin to split that it was impossible to see the difference. My thought process was the same when a patient with four or more diagnoses came in for a 4- or 6-month visit. I still had to review all of the meds, the problems, review previous labs and notes and address any new issues that came in. The tendency was to down code for fear of not including enough complexity to up code. This is another needless worry piled on the doctor's shoulders who already has enough to worry about. As you saw, you got audited and luckily you were able to document what you had done, and the fine was reduced. I had the same thing happen to me with Anthem years ago prior to EMR's and they wanted $1000 dollars from fees from two years prior. I was able to have it reduced to $100 but I had to spend a number of hours of providing the documentation. I had spoken to a doctor in Boston to whom I had sent the documentation and he told me that I had clearly done the work but to justify his time and his job he reduced the fine to $100. In essence, I got shaken down by the insurance industry. This is going to be happening more and more because the records are all there and AI will be looking for cut and paste notes and doctors who do this are going to get pounded. I see this as an intrusion into the doctor patient relationship which used be sacrosanct but no longer is. Woe to medicine!!!
That is the truth my friend!! 99213 or 214? Did the difference between 14 minutes and 16 minutes justify the 214? Enough comorbids? What if I am treating 4 separate conditions? UGH and every insurance company wants something different!! These audit shakedowns are ridiculous, and the hours that go into disputing them are man hours we could use for the ever ridiculous prior auths that pile up, thank you again to insurance companies!
Ironically, our EMR has crashed twice this week. It was down for half the day Monday and half the day Tuesday. I had to go back to paper notes and paper prescriptions. It was actually refreshing!!!! My handwriting is another story however…..😂
I said it before and I will say it again, the EMR has been the biggest detriment to the practice of medicine in my lifetime. The entire idea of chasing metrics in a pay for performance paradigm diluted patient care. The physician was forever chasing the carrot on the stick to increase his bonus which, in turn, reduced the time with the patient to actually treat the problem. The time spent in the doctor-patient encounter became skewed toward answering screening metrics as opposed to problem solving. EM coding was a contrivance to compensate for time spent with the patient, but it too has become tedious and not very helpful. Can anyone in practice really tell the difference from a 99213 visit to a 99214 or 99215 visit? In my mind the hair was so thin to split that it was impossible to see the difference. My thought process was the same when a patient with four or more diagnoses came in for a 4- or 6-month visit. I still had to review all of the meds, the problems, review previous labs and notes and address any new issues that came in. The tendency was to down code for fear of not including enough complexity to up code. This is another needless worry piled on the doctor's shoulders who already has enough to worry about. As you saw, you got audited and luckily you were able to document what you had done, and the fine was reduced. I had the same thing happen to me with Anthem years ago prior to EMR's and they wanted $1000 dollars from fees from two years prior. I was able to have it reduced to $100 but I had to spend a number of hours of providing the documentation. I had spoken to a doctor in Boston to whom I had sent the documentation and he told me that I had clearly done the work but to justify his time and his job he reduced the fine to $100. In essence, I got shaken down by the insurance industry. This is going to be happening more and more because the records are all there and AI will be looking for cut and paste notes and doctors who do this are going to get pounded. I see this as an intrusion into the doctor patient relationship which used be sacrosanct but no longer is. Woe to medicine!!!
That is the truth my friend!! 99213 or 214? Did the difference between 14 minutes and 16 minutes justify the 214? Enough comorbids? What if I am treating 4 separate conditions? UGH and every insurance company wants something different!! These audit shakedowns are ridiculous, and the hours that go into disputing them are man hours we could use for the ever ridiculous prior auths that pile up, thank you again to insurance companies!
Ironically, our EMR has crashed twice this week. It was down for half the day Monday and half the day Tuesday. I had to go back to paper notes and paper prescriptions. It was actually refreshing!!!! My handwriting is another story however…..😂