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PLAIDMAN

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I am wondering why I see so many coding articles, seminars, ect...that are relating to CODERS that you cannot bill for "cloned" notes....or that Epic has a "backdoor" button that you can go see WHO actually entered the chief complaint....

I code by DOS, I do not go back through the medical record and look at all notes to make sure they look different.
I have not received any training by Epic or otherwise showing me where to go snoop for who enter CC

I am not a part of management, quality control, compliance dept, I am not an auditor ....I am just a lowly coder....I thought this was management/physician responsibility ?

why are these types of things being directed at coders? what am I missing ?
 
I could be wrong, but I don't think that this is a HIPAA issue. However, cloned medical records are a huge compliance and audit risk due to the increased chance of upcoding and improper payment for services that may not have been perfomed. They have been on the OIG workplan for several years and are also part of the E/M audit focus that the RACs, PSCs and ZPICs have been focusing on for several years.

Several health plans, including Medicare and most Medicaid plans, have also caught onto the use of cloned medical records and are refusing to pay for services when they identify that the medical record has been cloned.

There is a good article on this in the March 2015 issue of Healthcare Business Monthly that will explain all of the pitfalls of cloned medical records. See the link below to check it out.

https://aapcperfect.s3.amazonaws.com/5548A1AF-4C9F-49A2-BFE0-BFA7D2344700/32ac5367-40be-4fbe-9ef1-71018ce33525/0a0da80c-e437-46a5-85ac-9ba19d213851.pdf
 
I agree with emcee. I don't think it's a HIPAA issue either. Cloning notes will raise a huge red flags for audits.

Lena

P.S. You are not lowly! You are a big part of the revenue cycle management team :)
 
It is not a HIPAA issue; it is a Fraud & Abuse issue. The concern is that providers may be documenting - and thus billing - work that they didn't really do.

I do not believe that it is the coder's responsibility to check for this; the only way this relates to a coder would be that if you have a reason to suspect that a note has been cloned, you would be responsible for reporting it to your supervisor.
 
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