tci Part B Insider - 2007 Issue 40

CLAIMS ACCURACY: Medicare Paid $1.7 Billion in Upcoded E/M Claims Last Year

But CERT report reveals improvements in coding accuracyIf your favorite code is 99205, watch out. A new CMS report reveals that nearly 25 percent of claims submitted to Part B for this code last year were upcoded.CMS- Comprehensive Error Rate Testing (CERT) program reviewed claims submitted between April 1, 2006, and March 31, 2007, and released the results last week. The most frequently upcoded E/M code was 99310 (Subsequent nursing facility care), which had a 26.3 percent error rate. Code 99205 (new patient visit) came in a close second, followed by 99204 (new patient visit, 21 percent...

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