Outpatient Facility Coding Alert - 2015 Issue 12
Reimbursement: Make Sure Your E/M Claims Aren't Part of the 14.6 Percent Error Rate
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Article Overview
This article reviews recent CMS CERT report findings that affect Medicare reimbursement, with a focus on evaluation and management claims, documentation problems, and billing issues involving non-physician practitioners. It is intended for coders, billers, compliance staff, and clinicians who want to understand common error categories, audit exposure, and the types of Medicare claims reviewed in the report.
Why This Topic Matters
It helps practices recognize broad risk areas in Medicare billing and documentation so they can assess whether their internal workflows align with current audit concerns and improper payment trends.
Article Sections
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Medicare Will Want Refunds
Summarizes the Medicare improper payment discussion, the CERT report context, and the main categories of claim review described in the article.
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Avoid These E/M Errors
Focuses on evaluation and management billing concerns, documentation issues, and the role of non-physician practitioner claims in the report's findings.
What You Will Learn
- How the article frames Medicare improper payment trends and CERT findings
- Which broad documentation and coding problem areas are highlighted
- Why evaluation and management billing is a recurring audit concern
- How non-physician practitioner claim billing is discussed at a high level
Who Should Read This
- Medical coders
- Billers and reimbursement staff
- Compliance and audit teams
- Physicians and practice managers
- Non-physician practitioners
Codes Discussed
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