decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 2 (February)
Coding errors decline, but E/M still confuses
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Article Overview
This article reviews CMS Comprehensive Error Rate Testing (CERT) findings on physician practice coding accuracy, with emphasis on documentation issues and evaluation-and-management (E/M) services. It is relevant to coders, compliance staff, and physician practices that monitor claim errors, documentation quality, and audit risk. The discussion focuses on trends in improper payments, common problem areas, and the types of services most frequently found in error.
Why This Topic Matters
Understanding CMS error trends helps practices identify where coding and documentation processes may need attention. The article is useful for recognizing why E/M-related claims continue to appear among the most common sources of error and why documentation quality remains a compliance concern.
Article Sections
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CMS CERT error-rate results
Summarizes the CMS Comprehensive Error Rate Testing program findings and compares error-rate trends across reporting periods. Discusses broader improper-payment patterns and overall payment changes.
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Areas to focus on: Documentation and E/M coding
Highlights documentation concerns and evaluation-and-management coding as recurring problem areas in physician claims. Notes the general pattern of services appearing in error and the relevance of code-level selection.
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Little change in improper payments
Reviews the reported improper-payment totals alongside changes in total Medicare payments. Places the error-rate findings in the context of overall spending growth.
What You Will Learn
- How CMS CERT reports are used to track physician practice coding accuracy
- Why documentation remains a persistent focus in claim review
- Which general service categories continue to appear frequently in error reports
- How overall improper-payment trends compare with total payment growth
Who Should Read This
- Medical coders
- Compliance staff
- Physician practice managers
- Revenue cycle professionals
- Auditors
Codes Discussed
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