tci Part B Insider - 2018 Issue 5

E/M Coding: CMS Continues to Focus on E/M Problem Areas

Incomplete documentation remains a top issue. Part B providers depend heavily on their evaluation and management (E/M) services to boost their income, seeing a majority of beneficiaries through these visits. Therefore, it's not surprising that Medicare reviewers routinely find significant but fixable errors in a large amount of E/M claims. According to the April 2018 Medicare Quarterly Provider Compliance Newsletter, CMS's CERT contractors are reporting that they have seen an increase in E/M claims issues due to improper coding, insufficient notes, and setting confusion. In fact, "the 2017 improper payment rate for E/M services was 12.1 percent, accounting...

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