Error Rates: Nail Down Your E/M Claims to Stay Off the Audit Hit List

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article explains a CMS CERT report focused on Medicare fee-for-service improper payments and how the findings relate to E/M coding and documentation. It is aimed at physicians, coders, billing staff, and practice leaders who want to understand broad audit-risk themes, documentation concerns, and non-physician practitioner billing issues. The discussion centers on error patterns, overpayment exposure, and the importance of internal education and review processes.

Why This Topic Matters

The article highlights why E/M claims and related billing workflows remain high-risk areas under Medicare audit review. Understanding the report’s themes can help practices assess documentation habits, billing oversight, and practitioner billing alignment before claims draw scrutiny.

What You Will Learn

  • How CMS CERT reporting is used to identify Medicare improper payment trends
  • Why E/M documentation and billing are frequent audit focus areas
  • What broad types of claim errors were observed in the report
  • How non-physician practitioner billing issues can affect claim review
  • Why coder-physician communication and documentation education matter in practice workflows

Who Should Read This

  • Physicians
  • Medical coders
  • Billing staff
  • Practice managers
  • Compliance professionals
  • Non-physician practitioners

Codes Discussed

  • CPT: 99214

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