Medicare Compliance & Reimbursement

The Centers for Medicare & Medicaid Services’ (CMS’s) recently released Comprehensive Error Rate Testing (CERT) report shows that medical practitioners left over $1 billion on the table by underbilling claims. It’s time to take a closer look at your billing practices in some key E/M areas.

 

The report, which was released last month, shows that chiropractic visits had far and away the most errors, totaling a 51.5 percent error rate in that specialty. Following behind were initial hospital care visits, which showed a 28.3 percent error rate, and lab tests, which were improperly billed 26.1 percent of the time.

 

Documentation: The majority of the errors that CMS found involved insufficient documentation, which comprised 56.8 percent of the incorrect payments. The next most common issues were medical necessity errors (26.6 percent), incorrect coding (13.7 percent) and no documentation (1.4 percent).

 

Downcoding: Not all errors involved upcoding, however. CMS actually found that $1.3 billion in coding errors were due to instances where practices reported lower codes than their documentation justified. This means that medical practitioners shorted themselves out of significant reimbursement last year.

 

Among the most often undercoded Part B services were kidney and urinary tract procedures, pacemaker implantations, outpatient hospital visits, established patient office visits, subsequent hospital care, and treatment of peripheral vascular disorders, the report notes.

 

Avoid These E/M Errors

Interested in avoiding the most common culprits that led to such a high Part B error rate? Then you should nail down your E/M claims going forward. The following errors stood out as the most glaring E/M problems among Part B practices: