Resource Corner Blog

…Do Not Collect $200 – Do Avoid Medicaid Fraud with EHR Hard Stops


Monopoly – The Friendship Ruiner

Monopoly is known for ruining friendships. As the number of hotels rises and the number in your bank account dwindles, your resentment grows until you start screaming at the person who snarkily said, “Do not pass go, do not collect $200” after sending you to jail and you overturn the board. No? Just me?

I guess my mom always did tell me I was competitive.

While I was sulking in Monopoly jail, I tried to look on the bright side – I couldn’t accrue more hotel debt since I couldn’t go anywhere for three turns. As I watched my “friends” land on hotels and lose their money, I realized this experience reminded me of something – electronic health records and ways to avoid Medicaid fraud.

Let me explain…

I was working with one of our new customers to configure their version of our software. They had various features and functionality they needed, including a set of specific hard stops. These hard stops would help to enforce their processes and limit their chances of committing Medicaid fraud.

We’ve all experienced hard stops. They’re the notification that pops up when you try to submit a form without completing the “necessary” fields. They stop you. They don’t let you pass go, they don’t let you collect $200.

Are Hard Stops really THAT helpful?

Though they can be frustrating for the user when you keep forgetting to fill out a field and need to go back to the form, hard stops are incredibly beneficial.  For behavioral health agencies when the consequences of audit findings can be severe. They can help ensure that information is completed accurately. You need to have an EHR that allows for hard stops in the following areas:

  1. Billing without a valid treatment plan

Depending on the type of program/service you are providing, hard stops should prevent your agency from billing if you don’t have a valid treatment plan. This gives your staff an incentive to complete their treatment plans. It also ensures that if Medicaid chooses to audit your organization, they’ll find a valid treatment plan attached to each billing file. They won’t be able to say that you provided a service without completing your treatment plan.

  1. Signing a progress note at the wrong time

If your appointment is scheduled from 1-2pm, and that is the time frame the service was delivered, your progress note should reflect that time and be signed when the appointment ends. For example, you shouldn’t be signing the note at 1:45pm. Hard stops in your EHR can stop you from signing and remind you that your progress note should match the appointment. This prevents you from billing incorrectly.

  1. Clinicians aren’t magicians…and neither are their clients

Clinicians can do a lot in 24 hours, but they aren’t magicians. They can’t be in more than one place at once. If a clinician writes a progress note for a group meeting from 1-2pm, they can’t write another one for a therapy session from 1:30-2:30pm.

Their clients aren’t magicians either – they also can’t attend a group meeting from 1-2pm and a therapy session from 1:30-2:30pm. Hard stops within your EHR will stop you if you try to document two services that overlap for you or your clients.

  1. My appointment was 500 minutes long

Sometimes fingers slip when you’re typing out information for what feels like the 100th time that day. You could easily mistype a 50-minute appointment as a 500-minute appointment. Hello, Medicaid fraud. Hard stops could lower that risk of human error by employing a maximum appointment time. If you try to submit anything beyond a feasible appointment range, it will stop you.

  1. Put more responsibility on the clinician

You can construct your EHR so that most fields are not pre-filled. This means that clinicians will have to manually go in and enter their information. If they don’t, they’ll see a hard stop reminding them to fill out the pieces that they’re missing. For example, if your appointment times pre-fill to show an hour, it’s easy to overlook that and bill your half hour appointment for an hour. If you have to fill the times out yourself, you’re more likely to do it correctly.

In some scenarios, it is more beneficial to have certain areas pre-fill. For example, filling in your client’s address multiple times is not helpful. You should only have to fill in their address once, and then your EHR can pre-fill it. Your EHR should be able to work with you in both capacities.

The goal of a hard stop is to lower the stakes of human error. By implementing them in your agency’s EHR, you also raise the standard for the quality of work your clinicians are producing and save yourself time in the long run.

But wait, there’s more?

While you won’t find medium stops in your EHR, you will also find soft stops in addition to hard stops. Soft stops act more as reminders than restrictions. They’ll let you bypass the warning and still complete the action if you choose. An example would be if you were going to prescribe ibuprofen to a client over 50. You would receive a “are you sure” message that you could ignore and continue with your prescription.

Soft stops are beneficial because they make you double check your decision. Hard stops are more effective when preventing Medicaid fraud because they will actually stop you from completing an action that will compromise you and you can’t easily skip them.

Hard Stops & Medicaid Fraud

Medicaid audits are either conducted randomly or because something in the agency’s documentation caused a red flag. In either scenario, the agency receives a letter stating the needed files. If they don’t have an EHR with hard stops, Medicaid will probably find several errors that will result in the agency paying a substantial fine. If they do have an EHR with hard stops, Medicaid is much less likely to have found errors that will merit a fine.

Hard stops within your EHR will ensure that you are completing your documentation and billing in compliance with Medicaid’s regulations. Your system should give you less to worry about by limiting the small mistakes that could cost you a lot. Utilizing EHR hard stops will help you avoid Medicaid fraud.

In addition to selecting an EHR that will work with you, you need to make sure that your staff understands the importance of details. Hard stops can only help you so much – you also need to be thorough in your documentation.

So hard stops are just like getting put in jail in Monopoly –

 – while irritating at first, they can save you money and worry in end. I guess the only difference is hard stops ruin far less friendships than Monopoly does.

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