tci Part B Insider - 2017 Issue 2

Compliance: Practices Short Themselves Out of $342 Million, Downcoded E/M Visits to Blame

Documentation woes continue to be a major problem for practices, CERT results reveal. Though upcoding errors still top the OIG’s hit list, it can be easy to forget that downcoding is a problem for many practices as well. And the latest CMS Comprehensive Error Rate Testing (CERT) results show that medical practitioners left over $1.2 billion on the table by undercoding claims in 2016. Downcoding blunders. CMS’s latest CERT results, which were released last month, show that practices forfeited $342.2 million alone just by downcoding established patient office visits (99211-99215). If you’re downcoding your...

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