Emergency Department Errors: ED Visit Claims Logged Over $260 Million in Errors Last Year

Why This Topic Matters

Emergency department claims can be a significant source of Medicare improper payments, so understanding the audit findings can help coding teams identify risk areas and strengthen internal review processes.

Article Sections

1. Emergency department coding errors in Medicare CERT findings

   Summarizes the Medicare improper payment context for emergency department claims and the role of CMS CERT reporting. Covers the general scope of the error findings and why ED visits were notable in the audit results.

2. Make sure you don't hit these hot buttons

   Introduces common ED claim problem areas discussed in the article, including general patterns of incorrect coding and undercoding. Focuses on the types of audit issues that can affect emergency department E/M claims.

3. Example 1

   Presents a sample emergency department visit scenario used to illustrate an ED E/M coding error review. Shows how the article frames a documentation-based comparison between two adjacent ED visit levels.

4. Example 2

   Presents another emergency department visit scenario involving a consultation and E/M level review. Discusses the example in the context of ED claim auditing and claim-level coding assessment.