Error rates: Get guidance on how you can reduce your prac-tice's coding, billing mistakes from the medical director of the CMS error rate program

Why This Topic Matters

Understanding where Medicare claim errors commonly occur can help practices improve documentation, reduce denials, and better prepare for audits or record requests. The article is relevant for providers and billing teams working in specialties with more complex evaluation and management reporting.

Article Sections

1. Medicare error-rate findings by specialty

   Summarizes CMS CERT study results and compares relative error patterns across specialties. It also notes the role of documentation non-response in the reported results.

2. Tips from the CERT doctor

   Introduces general guidance from the CERT medical director on improving reporting accuracy. The discussion centers on common problem areas identified by the error-rate data.

3. Critical care

   Addresses professional billing concerns for critical care services, including situations involving more than one physician and time-based reporting considerations. It also references related program guidance.

4. Subsequent Hospital Visits

   Reviews common documentation and visit-level issues associated with subsequent hospital care. The section explains the broad scenarios used to think about level selection and documentation review.

5. Consults (inpatient and outpatient)

   Covers the main criteria involved in consult reporting and the documentation elements that are often missed. It also discusses communication back to the ordering physician.