E/M Coding Alert - 2017 Issue 10
Compliance: Dodge These Perennial E/M Issues Found in the CERT Report
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Article Overview
This article discusses common evaluation and management compliance issues identified in Medicare CERT reporting and references CMS and MLN documentation guidance. It is aimed at coders, billers, clinicians, and compliance staff who need a broad understanding of why E/M claims are denied, revised, or flagged for improper payment review. The piece focuses on documentation completeness, claim support, record integrity, and the general categories of information expected in E/M records.
Why This Topic Matters
E/M services are a frequent source of improper payment findings, so understanding the recurring documentation and compliance themes can help organizations reduce risk and strengthen claim support.
Article Sections
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Why Is E/M Coding Such a Problem?
Introduces the article’s focus on recurring E/M compliance concerns and the role of Medicare CERT reporting. Summarizes the general causes of error and the impact on improper payment findings.
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Ensure Your Claims Back Up the Necessity for a Higher Code
Discusses the need for documentation to support the level of service reported and references broad E/M component requirements. Also notes the context of proposed changes to the E/M framework.
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Rectify Your Issues with These Tips
Covers practical documentation-compliance themes, including record completeness, signatures, and consistency across the chart. Includes references to CMS and MLN guidance on what should appear in supporting records.
What You Will Learn
- Why E/M services are a recurring compliance concern in Medicare reporting
- What broad documentation elements are commonly reviewed in E/M claims
- How CERT findings relate to coding errors and incomplete records
- What types of chart documentation help support claim integrity
- Which CMS and MLN guidance areas are referenced for E/M record support
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Physicians
- Clinical documentation staff
- Practice managers
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