📉 Your EHR Isn’t Helping—It’s Hurting Your Claims
EHR templates were designed to streamline workflows, standardize notes, and help providers meet documentation requirements faster.
But in 2025, they’ve become a top source of hidden claim contamination.
At Thrive, we’ve seen it firsthand: templates meant to speed things up actually introduce patterns that trigger payer audits, increase denials, and weaken appeal arguments.
🚨 The Problem: One Template ≠ One Size Fits All
Let’s break down what’s going wrong:
- Auto-populated fields that overwrite provider-specific content
- “Cloned” language that lacks patient-specific variation (red flag for fraud)
- Improper time documentation for time-based services (e.g., 99291, 99358)
- Overuse of default diagnoses not supported by medical necessity
- Inconsistent linking between history, assessment, and plan
These aren’t coding errors—they’re documentation design failures.
🔎 Real-World Case: When Templates Trigger Audits
In Q1 2025, a cardiology group using a single template for all follow-ups saw:
- A 37% increase in modifier 25 denials
- A Medicare audit citing “duplicative verbiage across encounters”
- Over $240,000 in delayed payments due to lack of time or MDM specificity
All because the template defaulted to “stable,” “continue current plan,” and “reassess in 3 months”—across hundreds of visits.
📊 How Bad Is It?
According to a 2025 MGMA/AMGA RCM survey:
- 62% of medical groups report denial increases tied to templated documentation
- 74% of appeal rejections cite insufficient documentation detail
- 83% of providers use EHR templates daily—but only 17% review them quarterly
🧩 Templates Are NOT Strategy
EHR vendors build templates for speed—not reimbursement accuracy.
That’s your responsibility.
Poor template structure affects:
- Risk adjustment (HCC capture & specificity)
- Audit defense (modifier 25, 59, time-based codes)
- Medical necessity documentation
- Procedure documentation granularity
- Payer-specific expectations
✅ Thrive’s EHR Template Audit Framework
At Thrive, we help clients deconstruct and rebuild EHR templates using:
🧠 Clinical + Coding Alignment
- Ensure templates prompt for required HPI, ROS, time documentation, and ICD specificity
- Remove vague or duplicative defaults
🔁 Crosswalk to Denial Trends
- Map recurring denials to specific template fields or workflows
- Flag EMR elements that increase claim rejection risk
📋 Note Simulations
- Run “what-if” simulations to see how real notes perform under audit or claim edit rules
👥 Provider Training
- Help clinicians recognize how template shortcuts create reimbursement risk
- Create specialty-specific templates that flex with documentation needs
💡 What You Can Do Right Now
- Pull your top 10 CPT codes and evaluate the corresponding note templates
- Review 20 randomly selected notes for each and flag repetition or auto-filled language
- Cross-check template output with the latest payer policies and LCDs
- Ask your coding/billing team which templates generate the most edits or rework
- Book a Thrive consult for a formal EHR Template Impact Assessment
🧠 Bottom Line
EHR templates won’t get you paid. In fact, they may be the reason you’re not.
Stop letting tech shape your notes—and start structuring your documentation to support clinical care and financial strength.
📣 Call to Action
🎯 Want to know if your templates are weakening your claims?