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Interesting article about fraudulent scribing practices - OCMT

Posted: Mar 09, 2014

Hmmmmmm...I think I'll pass on trying to become a scribe. I don't think I could do what this scribe is asked to do.

Thanks for sharing! - poorhouse

[ In Reply To ..]
Very interesting indeed! I never once entertained the idea of becoming a scribe. As a patient myself, would I want an MT in the exam room with me and the doctor? No, thank you. A medical student in training, yes, I'm cool with that but not a clerical person, which is what we're basically considered. Also, myself as an MT, I wouldn't feel comfortable in an exam room with a patient trying to discuss their personal health history with the doctor because I'm pretty sure they couldn't pay me enough to do that. lol

So, in the article where the author says the doc tells her to "just click that button" or "put in I listened to their heart"...what happens if the patient returns to the ER with aortic dissection that the doc missed the first time? Would the scribe be put on trial as a witness if the doc checked the patient thoroughly...as documented...the first visit?? Interesting!

But you do the same thing! - Coder

[ In Reply To ..]
That's one scribe's impression of things based on what he is able to see, and what he sees isn't the whole picture. Determining code levels is based on more than he said. It is also limited by the severity of the condition being treated.

He talked about getting to level 4 and 5, but you can't even get there if the patient isn't sick enough, no matter how much documentation there is. Many, if not most, physicians do not grasp this concept.

If you think physicians are strictly ethical about this, guess again. They game the system as much as possible. That is why CMS audits looking for fraud. They find it, too, and hospital systems and physicians pay back what they shouldn't have gotten along with fines.

Don't think you are not involved with this now, either. Dictating physicians simply dictate that they did more than actually occurred. You know those complete reviews of systems where nearly everything is negative? And those complete physical exams where nothing is wrong? Family and social history noncontributory? "Counseled on smoking"? "Use my normal"? Over and over again? That is all to pad the documentation to increase the amount they can charge.

And how many times have you transcribed an operative report that describes complicating factors that were never there? Extensive lysis of adhesions, for instance? That increases the payment.

The only thing saving you now is that you have no way to know it is happening. You are still participating in it.

Refusing to consider an entire occupational field because you might have to make ethical decisions is a bit much. There are few fields in which there are no ethical considerations. If anyone is unable to deal with this sort of thing, though, I would advise them to stay away from coding. These are everyday decisions for coders.

There is a HUGE ethical difference... - anon

[ In Reply To ..]
Between transcribing/entering information that a physician dictates (no personal interaction) than when a scribe is in the same room and witnesses that the doctor did NOT do what he/she tells the scribe to input. How anyone could miss this simple fact has me puzzled.

Nobody missed it - sm

[ In Reply To ..]
That post clearly says that the MT isn't aware of it. I think the point being made was that ethical issues are everywhere, not just in scribing, and refusing to consider scribing, or any job, because of something like this is throwing the baby out with the bathwater.

Very well said...because... - alwayswondered

[ In Reply To ..]
When I first started MT, I always thought there must be better doctors in other states, because every time I or any of my family have gone to the hospital, they NEVER do a review of systems, and they NEVER do a full complete physical exam. So, I can definitely see what Coder is talking about.

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