Outpatient Facility Coding Alert - 2015 Issue 16
Billing Errors: This MAC's Audit Finds That Some Practices Could Be Collecting More
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Article Overview
This article reviews a WPS Medicare CERT audit summary and discusses common documentation, coding, and billing issues identified in Part B practices. It focuses on evaluation and management coding patterns, including situations where claims were reported at lower levels than the records supported, and explains why those patterns matter for audit risk, reimbursement accuracy, and physician documentation habits. The piece is relevant for coders, billers, compliance staff, and practices that want to understand audit findings and coding trend concerns.
Why This Topic Matters
Audit summaries can reveal both overcoding and undercoding risks. Understanding the types of errors identified by a Medicare contractor can help practices improve documentation quality, reduce compliance exposure, and avoid leaving legitimate reimbursement uncollected.
Article Sections
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Downcoding Is Alive and Well
Discusses a Medicare audit summary from WPS Medicare and the broad categories of documentation and coding errors it identified. The section also introduces examples involving evaluation and management reporting patterns.
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It’s Not Just About the Money
Explains why repeated low-level coding patterns can attract attention during claims review and why accurate documentation and code selection matter beyond individual claim amounts.
What You Will Learn
- What types of documentation and coding issues were highlighted in a Medicare contractor audit summary
- Why repeated low-level evaluation and management coding can create compliance concerns
- How audit trend analysis can affect how practices are viewed by claims reviewers
- Why documentation quality is important for accurate code selection
Who Should Read This
- Medical coders
- Medical billers
- Compliance officers
- Physician practices
- Practice managers
Codes Discussed
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