Billing error rate: New data leads CMS to call for another round of AMA-sponsored work on E/M documentation reform: billing error rates increase over last year

Why This Topic Matters

CMS is using claims error data to highlight persistent documentation and coding problems in E/M services and to encourage broader documentation reform efforts. The article helps readers understand the policy and compliance context around Medicare billing accuracy, overpayments, underpayments, and documentation support.

Article Sections

1. CMS error-rate findings and response

   Summarizes the Medicare claims error-rate results and CMS’s reaction to the findings. The section frames the broader documentation and billing accuracy concerns tied to E/M services.

2. Collaboration on documentation reform

   Describes CMS outreach to the AMA and other medical groups regarding documentation guidance. It covers the general discussion of improving clinical examples and related documentation support.

3. Hospital visits, office visits, and overpayment/underpayment patterns

   Discusses the categories of services most often processed or paid in error and the broader patterns seen in Medicare claims. It also addresses the impact of documentation-supported billing differences on payment accuracy.

4. Documentation access and CERT review support

   Explains changes intended to help physicians obtain records for review and respond to documentation requests. The section also notes the role of CERT-related documentation assistance.

5. Suspected fraud

   Briefly covers the article’s discussion of referrals for possible fraud review and related program integrity activity. It also mentions a separate claims review effort involving independent diagnostic testing facilities.