General Surgery Coding Alert - 2017 Issue 7
NGS News: 55 Percent of 99215 Claims Incorrect, NGS Review Reveals
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Article Overview
This article explains why a significant share of reviewed Medicare claims for a high-level established patient office/outpatient visit were reduced or denied. It is aimed at coders, billing staff, compliance teams, and providers who want to understand the documentation, completeness, and authentication themes emphasized in the review, along with related Medicare guidance referenced in the discussion.
Why This Topic Matters
It helps practices identify broad documentation and signature vulnerabilities that can affect claim outcomes, compliance, and record integrity. The article also points readers to Medicare documentation expectations and signature authentication concepts that are important for medical review preparation.
Article Sections
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Confirm the Documentation is Crystal-Clear
Discusses documentation clarity concerns raised by the review, including general issues that can make records difficult to interpret or support.
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Ensure Documentation is Complete and Accurate
Covers completeness and accuracy problems in medical records and references general documentation elements tied to evaluation and management services guidance.
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Verify the Provider’s Signature
Summarizes Medicare authentication and signature-related considerations for medical review purposes, including general forms of acceptable provider authentication.
What You Will Learn
- Why documentation clarity matters in reviewed E/M claims
- Common record-completeness concerns discussed in the article
- General documentation elements referenced from CMS guidance
- Medicare signature authentication themes relevant to medical review
- How prepayment review findings can inform compliance efforts
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Physicians and other providers
- Practice managers
- Audit and revenue integrity teams
Codes Discussed
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