E/M Coding Alert - 2021 Issue 1
Improper Payment Rate: ‘Corrective Actions’ Decrease Overall Rates
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Article Overview
This article summarizes CMS’s FY 2020 Medicare improper payment rate findings and explains the broad categories of claim issues contributing to Medicare fee-for-service errors. It is relevant to coders, compliance staff, billing teams, auditors, and reimbursement professionals who monitor Medicare payment integrity, documentation quality, and CMS oversight efforts. The discussion also highlights the role of CMS and related contractors in reviewing claims and implementing corrective actions that affect reported error rates.
Why This Topic Matters
Medicare improper payment reporting can signal documentation and billing risk areas that affect compliance, audit readiness, and operational quality. Understanding the overall trends and major categories of error helps organizations identify where payment integrity reviews and documentation improvement efforts may be focused.
Article Sections
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Context and reporting update
Introduces the CMS reporting cycle, the CERT program, and the effect of the COVID-19 period on documentation collection and rate calculation methods.
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Here’s a Breakdown of the Numbers
Summarizes the overall Medicare fee-for-service improper payment findings for the fiscal year and compares them with prior-year estimates.
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Report Outlines Biggest Areas of Concern
Reviews the major categories contributing to the reported error rate and discusses the broad nature of the payment integrity issues identified by CMS.
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See How ‘Corrective Actions’ Impacted the Estimated Rates
Describes the general types of review and oversight activities CMS credits with helping reduce estimated improper payment rates.
What You Will Learn
- How CMS reports Medicare improper payment estimates
- What broad claim-error categories are highlighted in the FY 2020 report
- Which CMS review and corrective-action programs are discussed
- How documentation quality relates to payment integrity reporting
- How the article frames trends in Medicare fee-for-service error rates
Who Should Read This
- Medical coders
- Coding auditors
- Compliance officers
- Revenue cycle staff
- Healthcare administrators
- Billing specialists
- Physician practice managers
- Health policy analysts
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