Part B Payments: CMS: 11.3 Percent of ED Visits Were Paid Improperly

Why This Topic Matters

The topic matters because it connects CMS improper payment reporting with emergency department coding compliance and documentation practices, helping readers understand where ED claims are vulnerable to audit scrutiny.

Article Sections

1. CMS improper payment report and ED visit error rates

   Summarizes the CMS supplemental improper payment data and places emergency department services in the broader Part B compliance context. It also discusses the general categories of error identified in the report.

2. Avoid these common errors

   Reviews the types of payment errors seen in emergency department claims and the article’s general discussion of coding-related underpayments and overpayments.

3. Are you downcoding ED visits?

   Introduces the article’s discussion of emergency department visit level selection and the documentation areas that can affect coding accuracy.

4. Know what differentiates 99283 from 99284

   Compares the broad documentation elements associated with two commonly billed emergency department E/M levels and frames the discussion around history, examination, and medical decision-making.

5. Requirements of history

   Covers the history component of emergency department E/M documentation and the general structure of history elements referenced in the article.

6. Examination requirements

   Discusses the examination component of emergency department E/M documentation and the guideline frameworks referenced in the article.

7. Medical decision-making

   Explains the medical decision-making component of emergency department E/M services and the broad factors that influence its level.

8. Keep severity in mind

   Addresses the role of presenting severity in ED level selection and the article’s general reminder to align documentation with the service reported.