Does the adoption of EMR systems inflate medicare reimbursements?

Kartik K. Ganju, Hilal Atasoy, Paul A. Pavlou

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

The adoption of EMR systems has been argued to lead to physicians "upcoding" their patients to inflate insurance reimbursements. In this paper, we examine if the adoption of the Clinical Physician Order Entry (CPOE) system is associated with an increase in the complexity of the patients' case mix that hospitals report (termed "upcoding"). We make use of a staggered roll-out of the Recovery Audit Program to combat upcoding as a natural experiment to assess the impact of the adoption of the CPOE systems on the case mix that a hospital reports. We find that on average the adoption of CPOE systems is associated with an increase in the reported case mix of hospitals, and that the Audit program has had an effect on reducing the case mix that hospitals report to Medicare for reimbursement. Implications for preventing inflated reimbursements due to "upcoding" are discussed.

Original languageEnglish (US)
Title of host publication2015 International Conference on Information Systems
Subtitle of host publicationExploring the Information Frontier, ICIS 2015
PublisherAssociation for Information Systems
ISBN (Print)9780996683111
StatePublished - 2015
Externally publishedYes
Event2015 International Conference on Information Systems: Exploring the Information Frontier, ICIS 2015 - Fort Worth, United States
Duration: Dec 13 2015Dec 16 2015

Publication series

Name2015 International Conference on Information Systems: Exploring the Information Frontier, ICIS 2015

Other

Other2015 International Conference on Information Systems: Exploring the Information Frontier, ICIS 2015
Country/TerritoryUnited States
CityFort Worth
Period12/13/1512/16/15

Keywords

  • Case mix
  • Healthcare IT
  • Upcoding

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