In an article from FierceEMR today, it was reported that CMS and Medicare will be closely evaluating the use to Templates in creating patient notes. And paper templates and also included, not just electronic templates. Officials are worried that there might be improper insurance billing to medicare insurance and others. “[C]loned documentation will be considered misrepresentation of the medical necessity requirement for coverage of services due to the lack of specific individual information for each unique patient,” the notice states. “Identification of this type of documentation will lead to denial of services for lack of medical necessity and the recoupment of all overpayments made.”

The revised instructions state that CMS doesn’t prohibit the use of templates to facilitate record keeping, nor does it approve of or endorse any particular templates. Electronic records may involve any type of interface, not just sophisticated ones, with clinical decision and documentation support prompts. Templates can even be paper-based.

However, the agency discourages the use of templates that provide limited options for the collection of information, such as check boxes or predefined answers, or limited space to enter information.

Read more: Medicare contractor to docs: We won’t pay for cloned EHR notes – FierceEMR

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