Outpatient Facility Coding Alert - 2016 Issue 1
Error Rates: Nail Down Your E/M Claims to Stay Off the Audit Hit List
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Article Overview
This article explains a CMS CERT report focused on Medicare fee-for-service improper payments and how the findings relate to E/M coding and documentation. It is aimed at physicians, coders, billing staff, and practice leaders who want to understand broad audit-risk themes, documentation concerns, and non-physician practitioner billing issues. The discussion centers on error patterns, overpayment exposure, and the importance of internal education and review processes.
Why This Topic Matters
The article highlights why E/M claims and related billing workflows remain high-risk areas under Medicare audit review. Understanding the report’s themes can help practices assess documentation habits, billing oversight, and practitioner billing alignment before claims draw scrutiny.
What You Will Learn
- How CMS CERT reporting is used to identify Medicare improper payment trends
- Why E/M documentation and billing are frequent audit focus areas
- What broad types of claim errors were observed in the report
- How non-physician practitioner billing issues can affect claim review
- Why coder-physician communication and documentation education matter in practice workflows
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Practice managers
- Compliance professionals
- Non-physician practitioners
Codes Discussed
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