the chart automatically updates lab val-
ues, vital signs and test results to show
the most recent ;ndings during the en-
counter. “We do pull forward the old note,
but we update and edit it,” he says. “In the
paper world, it was easy to ;ip back and
look at old charts. In the electronic world,
think of the note as an evolving Wiki. I
can see what I did last time and docu-
ment what I am doing today.”
Berkowitz adds that his practice’s
EHR note system includes a clearly
marked area called “Problems Below Not
Addressed.” Any issues not taken care of
during a visit are denoted in that section
to clarify that the encounter did not cover
it. ;is helps the practice avoid billing for
services not rendered. It also helps with
the next visit by identifying potentially
lingering issues. “We are very clear about
what we do and do not address” during
an encounter, he says. “But we also want
to ensure we have a holistic view of the
patient’s medical issues so we don’t miss
anything either.”
;e set-up
Some experts say that the key to proper
billing rests in the way the EHR is set
up in the ;rst place. “;e implementa-
tion of EHRs can pose some risk due to
their ability to let users copy and paste
notes or auto-populate data ;elds,” says
Mary LeGrand, a consultant with Karen
Zupko and Associates, a Chicago-based
Lyle Berkowitz, M.D., says EHRs enable better charge capture. Prior to automation, many physicians underbilled for their services, he and other experts contend.
;rm which advises on proper coding and
billing practices. “;e strength of the
EHR is that it can capture work not pre-
viously captured in written documenta-
tion. ;at’s of signi;cant value. EHRs
themselves are not ‘bad’ in this regard. It
comes down to the implementation.”
Pulling an entire note forward does
pose risks, LeGrand says. If an identical
exam template shows up in subsequent
notes and the ;ndings are identical, it
raises two questions, she says. First, is
there medical necessity to do the same
exam in every visit? And second, were
the ;ndings really identical, or were they
just auto-populated results?
LeGrand suggests that practices conduct baseline audits of service levels
prior to EHR deployments. ;at can shed
insight into the billing levels before and
after the implementation. Moreover, the
auto-population feature needs to be controlled by physicians, she says. If it can’t
be modi;ed easily, it should be shut o;,
she recommends.
But shutting o; the auto-population
feature may undermine the very e;cien-cy a practice is seeking with the technology in the ;rst place.
“Physicians say if they turn o; the
feature and can’t easily import data from
previous encounters, they have lost the
value of the EHR,” she says. “You need
a mix. You have to use information that
was in the chart. Auto-population is OK
