One-level E/M errors: $855 million

Article Overview

This article reports on a Medicare payment integrity issue involving evaluation and management (E/M) coding differences that are only one level apart, and places it in the context of CMS’s Comprehensive Error Rate Testing (CERT) program and an AMA proposal under review. It is relevant for coders, auditors, compliance staff, and physician practices that track E/M documentation and payment error trends. The piece focuses on the broad nature of the error findings and the policy discussion surrounding them, without presenting detailed coding guidance.