Error rate auditors told to count E/M undercoding

Why This Topic Matters

The topic matters because audit findings can affect whether a practice is considered to have undercoded or overcoded services and can influence payment, compliance review outcomes, and internal documentation practices. The article also highlights common administrative issues that may arise during review, especially in emergency and office-based settings.

Article Sections

1. E/M undercoding in CERT audits

   Discusses how audit reviewers are instructed to examine E/M documentation for potential undercoding and how the review focuses on documented support for the level billed. It also frames the issue in relation to Medicare integrity review processes and physician coding practices.

2. Medical necessity and documentation review

   Addresses the distinction between documentation review and broader clinical judgment during audit evaluation. The section also notes commentary from coding and compliance professionals on how reviewers may approach E/M components and related documentation concerns.

3. TIP

   Provides a short practice-oriented reminder about reviewing electronic medical record systems for possible system-related coding errors.

4. Amnesty on 24-hour difference between claim, record

   Explains a CMS tolerance related to one-day differences between claim dates and medical record dates, along with discussion of when such discrepancies may appear during review. The section also mentions general steps practices may take when identifying a date mismatch before an audit.