Avoid Medicare Denials and Illegal Upcoding

Avoid Medicare Denials and Illegal Upcoding

With template-based EMRs you are at constant risk of illegally upcoding your Medicare documentation. Templates also expose you to the serious risk of generating “cloned” documentation, a practice that also violates Medicare policy. Both of these fundamental flaws in template technology are legal liabilities for your practice. Praxis is the only EMR that protects you.

According to Medicare policy, cloned documentation generated by template-based EMRs may "lead to denial of services for lack of medical necessity and recoupment of all overpayments made." Due to the structure of template technology, template-based EMR systems "clone documentation" when creating medical records. Medicare’s denial policy states that documentation which is worded exactly or nearly the same from patient to patient is considered “cloned,” and does not meet the medical necessity requirement.

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 or 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.

It would not be expected that every patient had the same exact problem, symptoms, and required the exact same treatment. Cloned documentation does not meet medical necessity requirements for coverage of services rendered due to the lack of specific, individual information for each unique patient.

Documentation exactly the same from patient to patient is considered cloned and often occurs when services have a specific set of limited or select criteria. Cloned documentation lacks the patient specific information necessary to support services rendered to each individual patient.

At Praxis, we have warned physicians about the inadequacies of this cookie-cutter approach to medicine for years. Template-based EMR systems force you to adapt your style of medicine to pre-set molds, interfering with the way you think through a medical case. Their rigidity makes it impossible for your EMR to evolve with you as you learn from experience and strive to adjust your practice to newly published medical findings.

Simply put, templates are counterproductive to the practice of high quality medicine. Due to the new Medicare denial policies, template-based EMRs not only lower your standard of care; they also lower your Medicare payments and put you at risk for “recoupment of all overpayments made.”

Don’t let this happen to you. Praxis is the only EMR that does not clone documentation. Instead, it allows you to chart electronically in free text using your own words, preserving the unique nature of your medical documentation.

Bottom Line: Praxis EMR creates a personalized and unique record for every patient. No template-based EMR does that.

Further, the limitations of templates facilitate Medicare upcoding and are therefore legally dangerous. Praxis captures patient visits at a level of detail that is impossible for templates to achieve. This ensures optimal Medicare coding every time.

  • Learn more about the Praxis PraxCoder (Read more)
  • See the Medicare policy on cloned documentation (Read more)
  • Learn more about malpractice and templates (Read more)

Still using Templates?  Switch to Praxis EMR and start saving 2-3 hours a day.