Outpatient Facility Coding Alert - 2015 Issue 30
Coding Errors: CMS: Improper E/M Coding Remains a Growing Problem
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Article Overview
This article reviews a CMS CERT report on Medicare fee-for-service improper payment trends and explains why evaluation and management billing remains a major source of risk for Part B providers. It is relevant to coders, auditors, compliance staff, and billing professionals who track documentation quality, incorrect coding, and payment error trends across Medicare claim types and settings. The article also notes geographic variation in error rates and discusses concerns involving non-physician practitioner billing and claims review findings.
Why This Topic Matters
The article highlights a rising Medicare improper payment rate and shows that E/M services continue to drive a substantial share of errors. Understanding the report’s scope can help healthcare organizations monitor compliance risk, strengthen documentation review, and identify areas where coding practices may be contributing to audits or refunds.
What You Will Learn
- How CMS CERT findings are used to assess Medicare fee-for-service improper payment trends
- Why evaluation and management services are a major source of Part B payment errors
- What broad documentation and coding issues are associated with improper payment findings
- How provider type and geography are discussed in the report context
Who Should Read This
- Medical coders
- Coding auditors
- Compliance professionals
- Billing staff
- Practice managers
- Revenue cycle professionals
Codes Discussed
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