tci Medicare Compliance & Reimbursement - 2015 Issue 19

Audits: Does Your Documentation Support Services Billed?

E/M coding still tripping up reimbursement. If 73.3 percent of your claims were denied or downcoded, your practice’s bottom line would be in the red — thankfully, your denial rates aren’t likely that high. That staggering percentage was, however, the number of 99223 claims NGSMedicare denied or downcoded in January this year, after a review. The reason? Documentation did not support the billed code. “You’ve all heard that acronym ‘TMI’ — well that doesn’t apply here, unless of course you send in claim information for dates of service that was not requested...

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