tci Medicare Compliance & Reimbursement - 2023 Issue Q1

Compliance: Documentation Issues Continue to Plague Medicare Providers

But, there were some outliers this year among the claims groups. If your Medicare claims don’t support the higher-level code for established E/M visits, be warned. The annual CERT report shows incorrect coding of these bread-and-butter office visits remain a thorny problem for Part B providers. Read on for the details. Context: On Dec. 8, 2022, the Centers for Medicare & Medicaid Services (CMS) published its “2022 Medicare Fee-for-Service Supplemental Improper Payment Data” as part of its Comprehensive Error Rate Testing (CERT) program. CMS uses CERT data to estimate improper payments and fix Medicare claims issues across...

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