Compliance: CMS: ED E/M Visits Responsible for $224M in Improper Payments

Why This Topic Matters

Emergency department claims are vulnerable to coding and documentation errors that can affect payment accuracy and compliance risk. Understanding the CMS error findings and the documentation themes discussed in the article can help ED practices review their reporting processes and reduce avoidable claim errors.

Article Sections

1. Emergency department improper payment overview

   Introduces CMS improper payment reporting and places emergency department services in the broader context of Medicare Part B error findings.

2. Emergency visits saw higher error rate last year

   Summarizes the reported error rates and the main categories contributing to emergency department payment errors.

3. Avoid these common errors

   Discusses common sources of ED claim error, including underpayments, upcoding concerns, and broader incorrect coding patterns.

4. Are you upcoding ED visits?

   Focuses on ED coding review considerations and the documentation themes associated with selecting an E/M level.

5. Checklist

   Reviews the general elements used in documenting history of present illness and gives a broad illustrative example.

6. Don’t forget this caveat

   Describes documentation caveats discussed in the article and references CMS and MAC guidance relevant to unavailable history information.