tci ED Coding & Reimbursement Alert - 2019 Issue 2

Know The Coding Errors That CMS Evaluated

CMS identified $31.6 billion in total improper payments among providers during 2018, and broke down those charges into a variety of categories. Check out the following breakdown of how many problems the agency found in each category, and how you can avoid making the same mistakes. Insufficient Documentation CMS found that the vast majority of improper payments this past year – 58 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 visit for ear pain.” The...

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