Compliance: E/M Services Remain Perennial Problems for Providers

Why This Topic Matters

E/M services represent a major share of provider billing, so recurring errors can affect reimbursement, compliance exposure, and audit readiness. Understanding the broad error patterns helps practices focus review efforts on documentation quality and consistent reporting.

Article Sections

1. Background

   Introduces the CMS CERT-related improper-payment report and frames the article’s focus on E/M coding issues across Medicare claims.

2. See What’s at the Heart of E/M Services’ Issues

   Presents the main themes behind the reported E/M payment errors and sets up the discussion of the most frequently problematic service types.

3. 1. 99223

   Discusses one of the highest-impact hospital care services identified in the report, along with general documentation and reporting concerns.

4. 2. 99214

   Covers an office or other outpatient established-patient service that appears prominently in the improper-payment data and is associated with common documentation and coding issues.

5. 3. 99213

   Reviews another frequently cited outpatient established-patient service and the broad error patterns noted in the article.

6. Resource

   Provides a source reference for readers who want to review the underlying CMS improper-payment data report.