Outpatient Facility Coding Alert - 2013 Issue 32
Medicare Errors: E/M Errors Top Medicare's List of Improperly Billed Codes in 2012
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Article Overview
This article summarizes CMS Comprehensive Error Rate Testing (CERT) findings for Medicare fee-for-service claims in 2012. It focuses on the overall improper payment picture and highlights the main categories of billing problems discussed in the report, especially evaluation and management claims, split/shared services, and geographic error trends. It is useful for providers, coders, compliance staff, and billing teams that monitor documentation quality and Medicare audit risk.
Why This Topic Matters
The article helps readers understand where Medicare billing errors were most common in the CERT review year and why those findings matter for compliance and audit readiness. It gives a practical sense of the documentation and coding areas that drew the most scrutiny, without replacing the underlying CMS report.
What You Will Learn
- What the CERT review is and what it measured for Medicare fee-for-service claims
- Which broad claim categories were reviewed in the 2012 improper payment report
- What types of billing problems were identified in the review process
- Which evaluation and management service categories were highlighted as having elevated error rates
- What the article says about split/shared service reviews
- Which states were noted for higher error rates in the report
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Physicians and group practices
- Revenue cycle teams
- Audit and documentation reviewers
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