General Surgery Coding Alert - 2012 Issue 28
Part B Errors: Assigning the Wrong E/M Code to Your Claims? You're Not Alone, CMS Says
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Article Overview
This article summarizes CMS Comprehensive Error Rate Testing (CERT) findings for Medicare Part B and highlights the types of services most associated with improper payments. It is relevant to physicians, coders, billing staff, compliance teams, and revenue cycle professionals who want to understand broad error trends, documentation shortcomings, and the categories of services most frequently affected. The discussion focuses on evaluation and management services, supplies, joint replacement procedures, and pacemaker procedures, along with the general kinds of documentation problems CMS identified.
Why This Topic Matters
Understanding CERT error trends helps healthcare organizations identify where claims are most vulnerable to improper payment findings and where documentation and coding review efforts may be most useful.
Article Sections
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CERT results and Part B error overview
Summarizes CMS’s reported Part B error rate and the general pattern of overpayments and underpayments in the CERT results.
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Evaluation and management services
Covers the role of evaluation and management services in Medicare errors and the documentation-related issues discussed by CMS.
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Supplies and documentation issues
Discusses supply-related error trends and the documentation themes CMS identified for certain billed items.
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Joint replacements and pacemaker procedures
Reviews procedure categories singled out by CMS for higher improper payment rates and the broad reasons those claims were found problematic.
What You Will Learn
- How CMS describes Part B error trends in its CERT findings
- Which broad service categories were associated with higher error rates
- What types of documentation problems CMS highlighted across multiple claim types
- Why certain procedure categories received particular attention in the report
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Compliance teams
- Revenue cycle professionals
- Practice managers
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