MACs reveal 8 mistakes that still endanger your office E/M revenue

Why This Topic Matters

The article helps readers understand why office/outpatient E/M claims may be denied or recouped and highlights the need for accurate documentation, internal review, and alignment with Medicare contractor guidance.

Article Sections

1. Introductory overview

   Introduces the Medicare contractor guidance discussed in the article and frames the main claim-edit and audit risks affecting office/outpatient E/M services.

2. Stop 3 pre-payment denials

   Describes common front-end claim problems that can prevent payment for office E/M services and discusses operational approaches practices may use to reduce them.

3. Bundling errors

   Covers contractor guidance related to global surgery and NCCI-related bundling issues that can affect office/outpatient E/M claims and modifier use.

4. 5 post-payment recoupment risks

   Summarizes documentation issues identified in post-payment review and targeted probe and educate activity for established-patient office visits.

5. Resources

   Lists external Medicare contractor and CMS reference materials cited by the article.