Medicare Compliance & Reimbursement

You're not only losing revenue--you're also coding improperly. CMS data from previous years shows that medical practices undercode E/M claims to the tune of over $1 billion annually -- that's money that physicians could  have collected based on their documentation, but forfeited because they reported a lower-level code than they should have. But remember that your responsibility as someone who submits claims to Medicare is to code based on the documentation -- anything else is incorrect coding. If your practice is downcoding claims, take note of the following reasons that you should code based on your documentation rather than undercoding. Could You Be Triggering an Audit? The number one reason that many practices undercode is because they don't want to "trigger an audit." However, coding all low-level E/M codes is sure to get a payer's attention, because the claims reviewers will be wondering why you never offer high-level evaluations to your patients. [...]