A physician gives a verbal order for a diagnostic test to a nurse but never signs it, which should keep the claim on ice until there’s authentication. But the hospital’s electronic health record (EHR) is not set up to ensure physicians sign or co-sign orders before submitting claims, a problem that will surface in audits and put claims at risk of denial.

That’s one of the mistakes hospitals make when they adopt or upgrade EHR systems or switch vendors, said Christine Anusbigian, specialist senior manager at Deloitte & Touche. It’s déjà vu. “You see some of the classic risks we have dealt with in health care regulatory compliance for the past 30 years rear their ugly head again,” added David Yarin, a principal at Deloitte & Touche.^[1] He doesn’t blame it on the EHRs “per se,” but they brought a change in the way that services are captured and documented.

Because EHR workflows may not have been set up properly to ensure compliance with certain Medicare regulations, they perpetuate some noncompliance. “We are seeing this across the country,” said Nancy Perilstein, specialist senior manager at Deloitte & Touche.