tci Medicare Compliance & Reimbursement - 2016 Issue 4

E/M Coding: These Errors Could Lead to Recoupments After Audits

Does your medical decision-making support the level of service billed? If 65 percent of your claims were downcoded or simply denied on review, it would ring alarm bells for you, wouldn’t it? Recent pre-payment reviews run by Part B payer NGS Medicare led to startling results. Read on to learn what you must do to avoid such a situation. NGS performed a pre-payment review on code 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical...

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