MLN Homepage Return to List Date 2017-06-29 Subject MLN Connects for June 29, 2017 MLN Connects banner Thursday, June 29, 2017 News &

In a study report, the Office of the Inspector General (OIG) noted that 42 percent of claims for Evaluation and Management (E/M) services in 2010 were incorrectly coded, which included both upcoding and downcoding (i.e., billing at levels higher and lower than warranted, respectively), and 19 percent were lacking documentation.  A number of physicians increased their billing of higher level, more complex and expensive E/M codes. Many providers submitted claims coded at a higher or lower level than the medical record documentation supports. Use the following resources to bill correctly for E/M services:

• OIG Report: Improper Payments For Evaluation and Management Services   
• Claims Processing Manual: Chapter 12, Section 30.6
• E/M Services Guide
• 1995 Documentation Guidelines for E/M Services
• 1997 Documentation Guidelines for E/M Services
• Frequently Asked Question on Use of 1995 and 1997 Guidelines
• Provider Compliance Tips for Evaluation and Management (E/M) Services
• Evaluation and Management Services Web-Based Training course available through the MLN LMS

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• Jun 29, 2017 - By CMS.gov
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• Jun 29, 2017 - By CMS.gov
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• Jun 29, 2017
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• Jun 20, 2017
  CMS Overpaid Providers $729 Million in Incentive Payments
• Jun 08, 2017 - By CMS.gov
  The Centers for Medicare & Medicaid Services (CMS) seeks public input on reducing the regulatory burdens of the Patient Protection and Affordable Care
• Jun 06, 2017
  United States Intervenes in Second False Claims Act Lawsuit Alleging that UnitedHealth Group Inc. Mischarged the Medicare Advantage and Prescription D
• Jun 01, 2017
  New This Month (June 2017)

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