tci ED Coding & Reimbursement Alert - 2020 Issue Q1

Part B Payment: CMS: ED Visits Log 11.7 Percent Error Rate

National Part B overall error rate is only 8.6 percent, the agency notes. Emergency departments are well known for seeing a wide variety of diagnoses on any given day, which can make coding a challenge, since there aren’t any set expectations of what types of patient conditions you’ll see. That has potentially caused confusion in coding ED visits — at least that appears to be the case based on CMS’ most recent report. The backstory: CMS issued its “2019 Medicare Fee-for-Service Supplemental Improper Payment Data” on December 18 as part of its Comprehensive Error Rate...

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