tci Medicare Compliance & Reimbursement - 2007 Issue 45

Claims Accuracy: Medicare Paid $1.7 Billion In Upcoded E/M Claims

But CERT report reveals improvements in coding accuracy If your favorite code is 99205, watch out. A new Centers for Medicare & Medicaid Services (CMS) report reveals that nearly 25 percent of claims submitted to Part B for this code last year were upcoded. CMS' Comprehensive Error Rate Testing (CERT) program reviewed claims submitted between April 1, 2006, and March 31, 2007, and released the results last week. The most frequently upcoded E/M code was 99310 (Subsequent nursing facility care), which had a 26.3 percent error rate. Code 99205 (New patient visit) came in a close second, followed...

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