ED Coding & Reimbursement Alert - 2014 Issue 31
Medicare Errors: E/M Errors Plague Medicare Claims Accuracy
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Article Overview
This article reviews Medicare Fee-for-Service improper payment findings from CMS’s Comprehensive Error Rate Testing (CERT) program. It focuses on the broad categories of claims errors, including documentation and coding problems, and highlights why evaluation and management claims are a major source of error for Medicare providers. The piece is relevant to billing staff, coders, compliance teams, and practices that want to understand common Medicare audit vulnerabilities and overall claims accuracy trends.
Why This Topic Matters
The article helps readers understand where Medicare claim errors are most likely to occur and why CERT findings can trigger repayment activity or additional scrutiny. It is especially useful for organizations that bill Medicare and want to monitor documentation and coding accuracy.
What You Will Learn
- How CMS measures improper Medicare payment rates through CERT
- Which broad types of claim errors are most common in the report
- Why evaluation and management claims are a major focus of Medicare claim accuracy reviews
- How split/shared E/M services are discussed in the context of improper payments
- Which provider categories and states are highlighted in the CERT findings
Who Should Read This
- Medical coders
- Billing staff
- Compliance teams
- Practice managers
- Healthcare administrators
- Physician offices
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