tci ED Coding & Reimbursement Alert - 2021 Issue Q1

Compliance: CMS: ED E/M Visits Responsible for $224M in Improper Payments

Fortunately, the 9 percent error rate in this category came down from last year’s total. Emergency departments have a wide range of coding options, not only including the ED E/M codes, but also imaging studies, specimen collections, fracture care, and a host of other services. This could create confusion when selecting the right level of service, as evidenced by the $224 million in improper payments that CMS attributes to emergency department specialists. The backstory: CMS issued its “2020 Medicare Fee-for-Service Supplemental Improper Payment Data” on December 21 as part of its Comprehensive Error Rate Testing (CERT) program...

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