Compliance: Practices Short Themselves Out of $342 Million, Downcoded E/M Visits to Blame

Why This Topic Matters

It helps readers understand broad Medicare compliance risk areas, especially where documentation and code selection issues can lead to payment loss or claim errors, and shows the categories CMS highlighted as common sources of improper payment.

Article Sections

1. Downcoding blunders

   Introduces the CERT results and discusses payment loss associated with downcoding in Medicare fee-for-service claims. The section focuses on office visit services and other broad service groups affected by undercoding.

2. Part B Works Both Sides of the Claims Game

   Summarizes Part B improper payment findings and identifies broad categories of services that contributed to the error rate. It also presents the main documentation-related categories CMS associated with incorrect payments.

3. How Do the States Stack Up?

   Reviews state-level Medicare improper payment variation and compares reported rates across selected states. It places those figures in the context of the broader CERT findings and claim-type comparisons.