tci Medicare Compliance & Reimbursement - 2009 Issue 9

MEDICARE ERRORS: Watch Out: E/M Codes Top the List of CERT Mistakes

Physicians documented their subsequent hospital care poorly. If you often rely on 99211, beware. A new CMS report reveals that more than 15 percent of claims submitted to Part B for this code between Sept. 2006 and Sept. 2007 were missing critical documentation, causing Medicare to request more than $24 million back from providers. The comprehensive error rate testing (CERT) report found 99211 billed inappropriately in the "insufficient documentation" category. Meanwhile, the CMS report indicates that Medicare paid out nearly $39 million more than it should have for subsequent hospital care code 99232 in the "no documentation" error category...

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