EHR vs. Medical Billing

[Sunshine3324]

I am in need of some advice and clarification, please.

I have owned and operated a very small medical billing business since 2006. I have one client in particular who I have provided billing services to since 2008. Recently, we have been trying to market our services to other medical practices in order to try to sign more clients. Unfortunately, we have had very little interest. So I asked my long-standing client if he would recommend us to any of his physician acquaintances who might be looking for a biller. He told me that he has recommended me to other physicians several times over the years, but that with the rise of EHR, most physicians do not need medical billers and coders these days. This comment just floored me!

Granted, I don't know much about EHR. But from what little I do know, I don't see how EHR has anything to do with billing, or at the very least, I don't see how the rise of EHR would make medical billers and coders obsolete. From what I understand about EHR, EHR is just simply a way to have a patient's medical records stored electronically, so that any doctor can review them without needing to wait for the paper records to transfer from one physician to the next. EHR is more about making treatment more efficient, and does not replace the need for a biller/coder. Am I understanding the concept of EHR correctly? If so, what does EHR have to do with billing? Why would EHR make billing/coding no longer necessary? I understand that a patient's insurance information may be stored on EHR, but you still need someone to actually bill the insurance for services provided, correct???

If it is true that medical billers are not needed as much these days due to EHR, this could very negatively effect my ability to make a living and for my business to succeed. So, for that reason, I would greatly appreciate any feedback from anyone who understands EHR and its relevance to the actual billing function! Thank you!

 

[Chelle-Lynn]

The Electronic Health Record (EHR) or Electronic Medical Record (EMR) is a complex system with multiple facets. One of the most utilized functions has been the ability of these programs to help code the claims. Examples are:

- Programs available to help level the E&M service for the provide by utilizing the documented history, exam, and MDM.
- Programs ability to aid the physician in locating ICD-10 by word look up, most used diagnosis, aids to help drill down on the 7-digit codes, etc.
- Programs ability to aid the physician in locating the Procedure codes, but the same process.

Because of these available functions providers are relying on these to help or provide the coding. Most of these systems are a check the box process which in turns helps to code vaccines, labs, etc. So in many cases the responsibility for "coding" is on the physician and his medical staff to "click" on the correct items to "code" the claim.

- Example: Provider clicks on the box that says that a pregnancy test was completed for the patient and 81025 is assigned for billing
The provider then clicks on the option for positive, negative, or inconclusive test results that then populates the dx ie Z32.01

So from the providers point of view this is great! Eliminates the need for coders, etc. Good for them, right? Sort of...but not really.

The down side is the misuse of the EHR to code claims as the physician may abuse the system. How? Well, if he sees that by one more system checked he bumps from a 99213 to 99214 that may encourage the provider to check one more system in order to get the higher level of service. This is an area that has been warned about for several years now as the medical community has driven towards the use of the EHR. In addition, we as coders know that just because the points are there, does not mean the service medical necessity meets the level being billed. Also, now with the ICD-10 expansion the need for additional or qualifying diagnosis codes is even more in demand.

So what we are beginning to see if a slight shift from physicians using "coders" to using "auditors". This may be an area that you would like to look into to build your clientele. In addition education with the providers is still in high demand.

Like all changes within our community there are positives and negatives. What most are seeing is a shift in the needs of the physicians office...so hopefully we are working towards shifting with them.

Please let me know if this does not explain the use of the EHR for your question. Please feel free to contact me directly at cjohnson@schsa.org.