tci Part B Insider - 2009 Issue 15

MEDICARE ERRORS: E/M Codes Top the List of CERT Mistakes, CMS Says

With over $600 million paid improperly, physicians didnt document their subsequent hospital care well. If your favorite code is 99211, watch out. 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 insufficientdocumentation category. Meanwhile, the CMS report indicates that Medicare paid out nearly $39 million more than it should have for subsequent hospital care code...

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