tci Part B Insider - 2019 Issue 2

Reimbursement: E/M Services Factor Heavily in Improper Payment Numbers

Mistakes are still in the billions, but the error rate is declining. If E/M services are the bread-and-butter of your Part B pay, you may want to double-check your claims for errors in 2019. Comprehensive Error Rate Testing (CERT) data suggest that E/M coding figures prominently in the 2018 improper payment rate — and the feds are targeting these services. Backstory: CMS released its “2018 Medicare Fee-for-Service Supplemental Improper Payment Data” as part of its CERT program. The CERT report breaks down the biggest Medicare claims errors while covering the causes of the improperly paid charges. The annual...

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