BC Advantage - 2016 Issue 5

Why are Evaluation and Management Services Being Scrutinized?

In 2014, the Office of Inspector General (OIG) shared a report titled, "Improper Payments for Evaluation and Management (EM) Services Cost Medicare Billions in 2010," which reported that 55% of EM service claims were incorrectly coded or lacking documentation, resulting in $6.7 billion in improper Medicare payments.[1] The OIG Work Plan is released annually, delineating areas of risk for fraud and abuse and how they intend to investigate them. Evaluation and Management services are constantly listed on the OIG Work Plan. With the possibility of recovering a large portion of that $6.7 billion, plus significant...

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