Outpatient Facility Coding Alert - 2007 Issue 40
CLAIMS ACCURACY: Medicare Paid $1.7 Billion in Upcoded E/M Claims Last Year
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Article Overview
This article reviews a CMS Comprehensive Error Rate Testing (CERT) report focused on Medicare Part B claim accuracy for evaluation-and-management services. It discusses broad patterns in coding errors, documentation issues, and reported year-over-year improvement in improper payment rates. The content is aimed at coders, billers, compliance staff, and practices that submit E/M claims and want to understand audit and error-rate trends.
Why This Topic Matters
The article helps readers gauge where Medicare claim errors are being identified and why coding accuracy and documentation remain important for compliance monitoring.
What You Will Learn
- How a CMS CERT report characterized Medicare Part B claim accuracy trends
- What broad types of E/M billing issues were highlighted in the report
- Why documentation quality and coding accuracy matter for compliance review
- How the report framed overall changes in improper payment rates over time
Who Should Read This
- Medical coders
- Billing professionals
- Compliance staff
- Physician practices
- Revenue cycle teams
Codes Discussed
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