ED Coding & Reimbursement Alert - 2012 Issue 21
Coding Errors: Initial Hospital Care, New Patient Office Visits Suffer Highest Error Rates, CMS Says
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Article Overview
This article summarizes CMS CERT data on improper payment and billing error rates reported across service categories and physician specialties. It focuses on evaluation and management services, hospital and office visit patterns, specialty-level error comparisons, and why accurate documentation and claim reporting matter for auditors and payers. The piece is intended for coders, auditors, billing staff, and clinicians who want a high-level view of where CMS identified the most and least accurate claims.
Why This Topic Matters
Understanding where CMS found elevated error rates helps billing and coding teams focus compliance review efforts, documentation improvement, and audit readiness on services and specialties that are drawing scrutiny.
Article Sections
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Background
Introduces the CMS CERT context and the reporting period discussed in the article. Summarizes the source of the data and the type of appendix material reviewed.
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E/M Services Rack Up High Errors
Reviews broad patterns in service categories with elevated billing error rates, including evaluation and management services and other high-error service types. Discusses the general compliance significance of these findings.
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Neurosurgeons, CRNAs See Low Error Rates
Summarizes specialty-level comparisons from the CMS data, highlighting groups with comparatively low and high error rates. Frames the implications for claims review and documentation oversight.
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CMS Eyeing E/M Codes
Describes the long-term CMS focus on evaluation and management coding accuracy and changes in error-rate trends over time. Addresses the broader audit attention directed at these services.
What You Will Learn
- How CMS CERT data is used to identify billing error patterns
- Which broad service categories had higher or lower error rates
- How specialty-level error comparisons can inform compliance attention
- Why evaluation and management services receive ongoing audit focus
- What general documentation and claim-accuracy issues are emphasized in the article
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Auditors
- Physicians and other clinicians
- Practice managers
Codes Discussed
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