Payer Focus: Watch Out for 2 E/M Error Hotspots CMS Uncovered

Why This Topic Matters

The article helps readers identify where E/M claims are most vulnerable to audit scrutiny and compliance errors. It is useful for organizations that bill hospital-based E/M services or allergy-related encounters and want to understand the types of documentation and coding issues CMS is flagging.

Article Sections

1. Check Your Inpatient Office Visits

   Discusses CMS findings related to evaluation and management services furnished in a hospital inpatient setting. It focuses on the general problem area, audit perspective, and how claims may be reviewed against the patient’s location on the date of service.

2. Use Caution for E/M With Allergy Visit

   Covers CMS compliance concerns involving E/M visits that occur with allergy testing or allergy immunotherapy. The section also addresses the documentation context for separate services and the use of modifier-related reporting.