Outpatient Facility Coding Alert - 2019 Issue 2
Reimbursement: E/M Services Factor Heavily in Improper Payment Numbers
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Article Overview
This article explains Medicare improper payment findings from CMS’s CERT program and summarizes why evaluation and management services draw significant attention in the error-rate data. It is useful for billing, coding, compliance, and reimbursement professionals who monitor Medicare payment integrity, claim review trends, and the types of services receiving increased oversight. The piece also places the findings in the context of broader Medicare Parts A, B, and DMEPOS improper payment reporting and mentions CMS education and review initiatives.
Why This Topic Matters
It helps readers understand which Medicare service categories are contributing to improper payment totals and why certain E/M claims may face heightened scrutiny from CMS and MAC review programs.
What You Will Learn
- How CMS CERT improper payment reporting is organized
- Why evaluation and management services are significant in Medicare error-rate data
- Which broad Medicare payment areas are discussed in the report
- How CMS frames improper payment trends and provider education efforts
- What geographic variation in improper payment rates is noted
Who Should Read This
- Medical coders
- Billing specialists
- Compliance staff
- Revenue cycle professionals
- Healthcare administrators
- Medicare claims reviewers
Codes Discussed
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