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Bottom line for doctors: those of us that use EHRs in the hospital, but also in the office, face potential scrutiny for billing driven by EHR software. This is a very contentious issue for CMS, having paid out more than $30 billion in incentives to entice providers into EHR use, now being faced with a potentially explosive and embarrassing scandal. Identification of “cloning” of records to generate higher reimbursement is rather easily shown (as those of you who read your colleagues’ notes can attest), and if CMS and the OIG decide to play hardball, a lot of providers are at risk. My prediction is that the scrutiny will initially be on the hospitals, following Sutton’s Law (“that’s where the money is”). The scut work will be done by Recovery Audit Contractors (RACs), which are private entities, paid bounties of 10-25% of recovered overpayments, and they are not eager to spend days/weeks in auditing records to recover a few thousand dollars from a physician practice, when the same time spent in a hospital could result in a million dollar payday.

Stay tuned!

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