Medicare Compliance & Reimbursement

Claims Accuracy:

Healthcare Practices Threw Away $259 Million Last Year

ASCs boast low error rates; general practices show the highest If the latest CERT report is any indication, you could have made a lot more money last year. According to the Comprehensive Error Rate Testing (CERT) results that the Centers for Medicare & Medicaid Services (CMS) released in late November, Medicare carriers discovered more than $259 million in undercoding billing errors, which means that medical practices shorted themselves that much last year. For example, the report highlights a practice that billed 40 units of J1756 (Iron sucrose, 1 mg). CMS discovered, however, that the practice actually injected 200 mg, which would have allowed it to have billed 200 units. That practice shorted itself over $200. The only non-E/M CPT codes on the list of the top 20 "underpayment coding errors" were 20610 (Major joint aspiration/injection) and 92012 (Eye exam), which puzzled some practices. General practices are error-prone: Error rates among the different provider types showed that general practices had an alarming 27 percent error rate, with ob-gyns close behind at 24 percent. The lowest error rates were found in claims from ASCs, CRNAs, interventional radiologists, mass immunizers and public health agencies. Avoid this $1,000 mistake: The CERT report offers examples of claims that contained errors. For example, one Part B payer reimbursed a physical therapist $1,120, but the claim reviewer couldn't find documentation of the physician's order, therapy evaluation or plan of care, causing the reviewer to count the entire payment as an error.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more