tci Medicare Compliance & Reimbursement - 2018 Issue 8

E/M Coding: Incorrect Codes, Poor Notes, and Setting Debacles Add to E/M Fails

CMS sees uptick in E/M claims problems. Evaluation and management (E/M) services are the bread and butter of most Medicare providers' paychecks. For this reason, routine errors related to mismatched codes and inadequate documentation put E/M at the top of most Medicare auditors' checklists. According to the April 2018 Medicare Quarterly Provider Compliance Newsletter, CMS's CERT contractors are reporting that they have seen an increase in E/M claims issues due to improper coding, insufficient notes, and setting confusion. In fact, "the 2017 improper payment rate for E/M services was 12.1 percent, accounting for 10.6 percent of the...

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