tci Medicare Compliance & Reimbursement - 2017 Issue 2

Reimbursement: Practices Found Themselves Out $342 Million with Downcoded E/M Visits to Blame

Insufficient documentation leads the error list, the 2016 CERT results reveal. Though upcoding errors still top the OIG’s hit list, it can be easy to forget that downcoding is a problem for many practices as well. And the latest CMS Comprehensive Error Rate Testing (CERT) results show that medical practitioners left over $1.2 billion on the table by undercoding claims in 2016. Downcoding blunders. CMS’s latest CERT results, which were released last month, show that practices forfeited $342.2 million alone just by downcoding established patient office visits (99211-99215). If you’re downcoding your office visits...

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