Part B Payment: CMS: ED Visits Log 11.7 Percent Error Rate

Why This Topic Matters

ED visit coding is a high-volume area with elevated improper payment findings, so understanding the CMS error patterns can help organizations focus auditing, documentation improvement, and compliance efforts.

Article Sections

1. Emergency Visits Logged Millions in Part B Errors

   This section summarizes the CMS improper payment findings for emergency department visits within the broader Medicare Part B error-rate report. It provides the article’s main statistical context and identifies the broad categories of payment issues discussed.

2. Avoid These Common Errors

   This section discusses common emergency department coding problems identified in the report and places them in the context of underpayments, overpayments, and incorrect coding. It also frames the discussion around documentation quality and coding review efforts.

3. Are You Upcoding ED Visits?

   This section focuses on emergency department E/M documentation and coding review considerations. It discusses general documentation expectations, history elements, and the importance of supporting the selected service level.

4. Checklist

   This section outlines broad history-of-present-illness elements that may appear in emergency department documentation. It includes a sample scenario illustrating how documentation detail is assessed at a general level.

5. Don’t Forget This Caveat

   This section explains documentation circumstances that can affect history and examination completeness in emergency department settings. It also references related CMS and CPT documentation concepts and examples of situations that may limit obtaining information.