Medicare Compliance & Reimbursement - 2009 Issue 15
MEDICARE ERRORS: E/M Codes Top the List of CERT Mistakes, CMS Says
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Article Overview
This article reviews a CMS Comprehensive Error Rate Testing (CERT) report focused on evaluation and management claim errors in Medicare Part B. It highlights which service categories were most affected, discusses documentation-related findings, and cites commentary from coding professionals about why these claims may be vulnerable to review. The piece is aimed at coders, auditors, and physician practices that bill office, consult, and hospital E/M services.
Why This Topic Matters
Understanding CERT findings helps providers and coding staff identify claim types that are more likely to trigger Medicare scrutiny and documentation-related payment issues. The article is relevant for compliance review, audit preparation, and awareness of common E/M billing problem areas.
What You Will Learn
- Which Medicare Part B evaluation and management claim categories were most affected in the CMS CERT report
- How documentation issues can influence error classification in hospital and office-based services
- Why consults and new patient visits may be subject to higher error rates
- What the report suggests about common vulnerabilities in physician charting and billing review
Who Should Read This
- Physicians
- Medical coders
- Medical auditors
- Compliance staff
- Practice managers
Codes Discussed
Code Ranges Discussed
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