Wiki Dilema: EMR templates documents things that were not done

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neatmon

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I am facing a ethical dilema here at work. The family physicians use a template for their office visits. The templates are pre-loaded with ROS and exam documentation, and it is up to the physician to edit such. The problem? The physicians do NOT edit. The office visit documentation for an encounter my minor daughter recently had with one of the physicians was totally bogas. I was in the room and witnessed the actual encounter. So, because of the level of visit that was reported to my insurance company, I am left with a higher balance than I should be, based on the ACTUAL encounter level that should have been reported.

This, to me, presents an abuse/fraud opportunity, and, because I have only been employed with them less than three months, I am uncomfortable at the thought of telling the CEO and powers that be that...uh...perhaps they need to re-think the pre-loaded templates..

Your thoughts please......
 
Do you have a compliance officer at your facility? Issues of compliance (such as you are definitely talking about here) can be reported in a confidenital manner so that you're not associated with the report. There are federal laws to protect you from retaliation, so that you needn't worry about losing your job for reporting this.
 
From what I understand, most EMR systems give you the ability to change the ROS and Exam, and other areas as well. This is one of the responsibilities that I have is correcting and updating our templates so that we are in compliance. Find out, and maybe suggest that you start looking over the templates. This may help raise your value to the company as well!
 
Pam's suggestion that you go to the practice's compliance officer is an excellent one. One of the things that the health care reform legislation recently passed did was to require compliance programs for any provider accepting federal $s (Medicare, Medicaid, TriCare, etc.) so if you don't have one, sounds as if the practice could use one. I would also caution you (and others posting to the forum) to be careful what you say since we can all be identified - probably better to speak in hypotheticals - none of us would want a federal investigator on our doorstep asking "tell me more about this fraud where you work...." Keep in mind that there are certified coders in these positions as well as in the private sector. Just a word of caution.
 
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