tci ED Coding & Reimbursement Alert - 2021 Issue Q1

Check the Coding Errors That CMS Evaluated

CMS identified a total of $25.74 billion in total improper payments among providers sampled in the 2020 CERT report, and broke down those charges in a variety of categories. Check out the following explanation of how many issues the agency found in each section, and how you can avoid making the same mistakes. Insufficient Documentation CMS found that the vast majority of improper Medicare payments — 63.1 percent — were due to insufficient documentation. In these situations, the medical records do not substantiate whether the service was medically necessary. Example: The documentation includes the phrase “ED...

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