tci Part B Insider - 2016 Issue 2

Coding Errors: Practices Shorted Themselves Nearly $210 Million in Downcoded E/M Visits Last Year

CERT results reveal that insufficient documentation topped list of Part B errors last year. With all the talk about the OIG coming after you for upcoding errors, it can be easy to forget that downcoding is a problem for many practices as well. And the latest CMS Comprehensive Error Rate Testing (CERT) results show that medical practitioners left over $1 billion on the table by undercoding claims in 2015. CMS’s new CERT results, which were released last month, show that practices forfeited $209.3 million alone just by downcoding established patient office visits (99211-99215). If you’re downcoding...

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