We monitor trends in Comprehensive Error Rate Testing (CERT) errors in order to identify areas where additional education may be needed.
There is an increasing trend of under coding in evaluation and management (E/M) services. It’s important to code the level service that is supported by your documentation – right coding. Visit the Evaluation and Management page (JH) (JL) of our website to explore the tools that are available, such as the Interactive E/M Score Sheet Tool. In addition, we offer regular education on coding E/M through webinars and symposiums.
You may be asking: “What’s the problem with under coding? Aren’t I saving Medicare program dollars by billing lower levels of service?” CERT is a measure of improper payments. The goal of CMS and Novitas is to pay claims that meet Medicare’s requirements and pay them at the proper level of service. When there is an underpayment due to under coding, we did not pay the claim correctly and it is counted as an improper payment error. You are reimbursed for the higher level of service. Under coding misrepresents the true level of care provided to Medicare beneficiaries.
Under coding errors can statistically impact calculated error rates in the tens of millions of dollars. These statistics are used to calculate future Medicare payments and track trends in healthcare delivery. Patterns of under coding may be viewed as aberrant and open your practice up to audits and reviews. In addition, under coding impacts your practice revenue. You are not being appropriately paid for the level of service you provide to your patients. Correcting under coded claims can mean costly appeals.
Each note should be unique and contain details of the particular visit or service for the patient. The documentation should be consistent with other parts of the medical record.
If you use Electronic Medical Records, be cautious using features like auto-fill or auto-prompt as they can be misused.
Cloning, which is copying and pasting information from a prior note into a new note may lead to a higher code and does not accurately reflect the actual service provided. The selected code should reflect the service provided.
When you practice right coding, coding the level of service supported by your documentation, we all win – you, your patients and the Medicare program.