A recent CMS statement from October 11 paints a disturbing picture for all physicians billing Medicare:

Medical Record Cloning

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.

So let me get this straight – about a decade ago, CM(M)S introduced their E&M Coding Guidelines that saddled primary care physicians with exquisitely complicated guidelines for E&M coding based upon the specific data elements captured in visit documentation.

As a result, physicians moved towards template-driven documentation and coding systems so they could code accurately based upon these arcane rules, which are impossible to consistently obey outside of an automated electronic system.

Now, CMS is giving us notice that they reserve the right to claw back all payments to a physician within their statute of limitations if it is determined that patient documentation is “exactly like or similar to” previous entries – when their own rules have forced that same consistency on providers?

Joseph Heller would be proud – Catch-22 is alive and well.

As CMS announces increased funding for RAC audits, and observing the tools with which these commission-based auditors are equipped, more physicians are realizing that money from the government should be approached like a mouse approaches cheese on a trap: it’s not food, it’s bait.

To this point, consider the Congressional testimony of North Carolina physician Dr. Karen Smith:

All of us at Physician Care Direct are committed to helping you grow a prosperous practice by contracting directly with employers and individual patients. We look forward to empowering your success.