Study: EHRs Do Not Prompt Hospitals To Overbill Medicare

July 9, 2014 in News

Electronic health records do not raise the risk of hospitals overbilling Medicare, according to a study published this week in the journal Health Affairs, EHR Intelligence reports (Bresnick, EHR Intelligence, 7/9).


In 2012, a Center for Public Integrity investigation, as well as a New York Times analysis, found that EHR systems could be contributing to a rise in upcoding, a process in which health care providers overbill by selecting higher-paying treatment codes.

In September 2012, Attorney General Eric Holder and HHS Secretary Kathleen Sebelius sent a letter to several health care and hospital associations warning that the Obama administration will not tolerate hospitals’ attempts to “game the system” by using EHR systems to boost Medicare and Medicaid payments (iHealthBeat, 7/22/13).

Details of Study

For the new study, researchers examined whether U.S. hospitals using EHRs had greater increases in the severity of patients’ conditions and in overall Medicare billing than hospitals that had not yet adopted EHRs (University of Michigan release, 7/8).

Specifically, the researchers compared billing records from 2008 to 2010 on 393 hospitals that had adopted EHRs with the billing records of 782 hospitals that were using paper records (Adler-Milstein/Jha, Health Affairs, July 2014). They organized their research so hospital comparisons involved hospitals of the same size and type, such as a teaching hospital or a for-profit organization (Whitney, NPR/Kaiser Health News, 7/8).


The researchers found that both hospitals using EHR systems and those using paper records increased the weight of their coding at nearly identical rates. The findings held across several sub-groups, including:

  • For-profit hospitals;
  • Hospitals in very competitive markets; and
  • Hospitals with the highest proportion of Medicare patients (Tahir, Modern Healthcare, 7/8).


Ashish Jha, one of the study authors and a researcher at the Harvard School of Public Health, said policymakers should not “worry about excessive billing” in hospitals that have adopted EHR systems because the “empirical evidence says this should not be a big focus of attention.”

However, Donald Simborg, an EHR expert and policy adviser, said that the study examined inpatient stays rather than emergency departments and outpatient clinics. He said that hospitals “already have software that helps them” maximize inpatient hospital stay billing, but that EDs and outpatient centers are just now acquiring digital record keeping systems, which sometimes spurs providers to over-document and overbill (NPR/Kaiser Health News, 7/8).

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