Catch-22’s Abound in Medicare’s “Clone War”

Get ready for Medicare’s war against “cloning of medical records.” You’re likely to get hurt if you’re not careful.

Here’s a direct quote from an October 11 statement from Center for Medicare/Medicaid Services (CMS) regarding a nuance of its policy on medical records:

“When documentation is worded exactly like or similar to previous entries, the documentation is referred to as cloned documentation.

Whether the cloned documentation is handwritten, the result of pre-printed template, or use of Electronic Health Records, cloning of documentation will be considered misrepresentation of the medical necessity requirement for coverage of services. Identification of this type of documentation will lead to denial of services for lack of medical necessity and recoupment of all overpayments made.”

So let me get this straight — about a decade ago, CMS introduced their E&M Coding Guidelines that saddled primary care physicians with exquisitely complicated guidelines for E&M coding based upon the specific data elements captured in visit documentation.

As a result, physicians moved towards template-driven documentation and coding systems so they could code accurately based upon these arcane rules, which are impossible to obey consistently in the absence of an automated electronic system.

Now, CMS is giving us notice that they reserve the right to claw back  all payments to a physician within their statute of limitations if it is determined that patient documentation is “exactly like or similar to” previous entries — when their own rules have forced that same consistency on providers?

Joseph Heller would be proud — Catch-22 is alive and well.

As CMS announces increased funding for RAC audits, and observing the tools with which these commission-based auditors are equipped, more physicians are realizing that money from the government should be approached like a mouse approaches cheese on  a trap. It’s not food, it’s bait.

William “BJ” Lawson, MD, is a physician & health care entrepreneur with a background in engineering and healthcare information technology. Based in Cary, NC, he is CEO of Physician Care Direct, a company that fosters the growth of direct-pay primary care practices, empowers physicians to contract directly with local small businesses, resulting in improved outcomes & greater cost efficiency.

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