E/M Coding Alert - 2008 Issue 20
MEDICARE ERRORS: Insufficient Documentation Cost Practices $1.3 Billion in 2007
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Article Overview
This article reviews Medicare Comprehensive Error Rate Testing (CERT) findings for claims submitted during a 2006-2007 period and explains why documentation problems continue to drive major payment errors. It is relevant to physicians, practice managers, coders, and compliance staff who need to understand audit risk, documentation burden, and the types of review findings that can affect reimbursement. The discussion also touches on specialty-level error patterns and the role of coding, bundling, and modifier consideration in complex procedures.
Why This Topic Matters
Understanding CERT error findings helps practices identify documentation and compliance vulnerabilities that can lead to reimbursement recovery, audit scrutiny, and avoidable payment losses. The article highlights why thorough recordkeeping and coding compliance matter across specialties.
Article Sections
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CERT results and overall Medicare error trends
Summarizes the reported CERT findings, including the overall improper-payment picture and how the error rate changed over time. The section provides context for the scale and categories of Medicare payment errors.
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Documentation-related errors and a claim example
Discusses missing and insufficient documentation findings and illustrates how record-request issues can affect claim review outcomes. The section focuses on the types of documentation problems identified in the report.
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Specialty-level error patterns and coding complexity
Reviews which specialties showed higher error rates and comments on the complexity of coding in certain procedures. The section also references broader coding and compliance considerations associated with complex claims.
What You Will Learn
- How Medicare CERT findings are used to measure claim error patterns
- Why documentation problems remain a major compliance issue
- Which specialties were noted for higher error rates
- How coding complexity can affect review risk in certain procedures
- What kinds of documentation and coding issues may draw payer attention
Who Should Read This
- Physicians
- Practice managers
- Medical coders
- Compliance staff
- Revenue cycle professionals
- Auditors
Codes Discussed
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