General Surgery Coding Alert - 2012 Issue 16
Coding Errors: CMS Unveils Error Rates: Chiropractic And E/M Services Top The List
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Article Overview
This article reviews CMS Comprehensive Error Rate Testing (CERT) findings for 2010 and highlights broad billing error trends across Part B services and physician specialties. It is intended for coders, billing staff, and clinical practices that want to understand which service categories and specialties were associated with higher or lower improper payment rates in the published appendices. The article also discusses CMS scrutiny of evaluation and management services and places the reported trends in the context of documentation and claim accuracy.
Why This Topic Matters
Understanding CMS error-rate reporting helps practices recognize where claims may attract review and where documentation quality matters most. The article is relevant to organizations that bill E/M services or work in specialties identified in the CERT tables.
Article Sections
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Background
Introduces the CMS CERT results for 2010 and explains that the appended tables provide more detail on service categories and specialty trends.
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E/M Services Rack Up High Errors
Summarizes the report’s findings for evaluation and management service categories and other high-error service types.
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What this means:
Provides broad guidance about claim accuracy and documentation for services discussed in the error-rate tables.
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Neurosurgeons, CRNAs See Low Error Rates
Describes specialties that showed lower error rates in the CERT report and contrasts them with higher-error groups.
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What this means:
Offers general observations about payer review and the importance of complete documentation for affected specialties.
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CMS Eyeing E/M Codes
Reviews longer-term CMS attention to evaluation and management coding and summarizes trends reported for one outpatient E/M code over time.
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What this means:
Discusses the need for documentation-supported E/M reporting and the risk of both overcoding and undercoding.
What You Will Learn
- How CMS CERT reporting is used to identify billing error trends
- Which broad service categories were highlighted as having elevated improper payment rates
- Which specialties were associated with higher or lower error rates in the report
- How CMS has monitored evaluation and management services over time
- Why documentation quality is important when reporting E/M services
Who Should Read This
- Medical coders
- Billing and compliance staff
- Physician practices
- Specialty clinic administrators
- Revenue cycle professionals
Codes Discussed
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