tci Part B Insider - 2014 Issue 31

Note These Additional CERT Areas of Concern

Although E/M claims ranked very high among Part B errors on the government’s most recent CERT report, those weren’t the only services that CMS spotlighted as being problematic. Consider these additional areas spotlighted in the “Medicare Fee-for-Service 2013 Improper Payment Report” when ensuring that you are coding properly. Joint replacements. CMS found a 5.8 percent error rate for major joint replacements, and most of those errors were due to a lack of medical necessity for the procedure. If you perform a joint replacement and the documentation does not demonstrate that the surgery was medically necessary...

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