CERT results disclose $34.3 billion in inappropriate Medicare payments--$1.1 billion of which was underpaid.
In case your practice's collections rate was off by 10.5 percent, you'd be in big worry, right? In fact, that's the 2010 Medicare Fee-for-Service improper payment rate, and your MAC might come looking for money you still owe to them. Read this article and guarantee accurate medical coding.
CMS's novel Comprehensive Error Rate Testing (CERT) results, which were out in November, explain that practices in fact made fewer errors in 2010 than in the preceding year. Maximum of the errors were revealed as overpayments—implying that CMS recognized $33.2 billion that went out to Medicare providers in mistake, and there are chances that MACs will be asking for much of that money back, if they haven't by now. Furthermore, CMS noted that it still owes $1.1 billion to providers who were underpaid in 2010.
To generate the CERT report, CMS revised 30,965 Part B claims, together with claims from Part A and DME, as per the "Medicare Fee-for-Service 2010 Improper Payment Report." Auditors then pored over the claims to decide which had no documentation, inadequate documentation, incorrect medical coding, or was a medically unnecessary service.
Documentation: Part B practices were the complete worst of the provider types as far as documentation was concerned, with a 2.1 percent error rate in the "insufficient documentation" category, greater than both Part A and DME providers.
Warning: In case a reviewer reviews your claim and discovers only a listing of the CPT® and ICD-9 codes that you reported, you have not proven medical necessity for the service, or even established that you in reality saw the patient. In these circumstances, the MAC could request the whole payment back.
Incorrect medical coding: Part B providers also rated the maximum among incorrect medical coding errors, with a 0.8 percent error rate, which topped the Part A and DME rates. Once more, not all of these errors reflected overpayments to practices--in few cases, doctors in reality shorted themselves by coding erroneously.
Avoid These Top 5 Physician Documentation Errors To Ensure Accurate Medical Coding
CMS found that physicians inappropriately billed $6.22 billion in claims that were later found to have inadequate documentation. In case you want to evade that type of error--which will lead to inaccurate medical coding--check out the top five errors:
1. No signature. Medicare needs that the author of a note validates it with a handwritten or electronic signature, however found that $1.3 billion worth of claims in reality had no signature at all.
2. Several errors. CMS noted that it inappropriately paid $1.1 billion on claims that had numerous dissimilar types of documentation errors.
3. Documentation does not go with code billed. "If it wasn't documented, it wasn't done." Medicare reviewers wholeheartedly agree with this sentiment, and said that physicians may have billed a particular code to the MAC, however the documentation didn't support it, causing $0.9 billion in errors in this category.
4. Effective physician order missing. Many services need a physician order. CMS discovered that the order was absent in $0.7 billion worth of claims.
5. Illegible identifier. In case a physician's signature is illegible or missing, CMS will give the provider an opportunity to attest to his signature. But, if the doctor does not return the attestation, the practice has to return the money it collected for the visit. CMS discovered $0.7 billion worth of errors in this category in 2010.
In case your practice's collections rate was off by 10.5 percent, you'd be in big worry, right? In fact, that's the 2010 Medicare Fee-for-Service improper payment rate, and your MAC might come looking for money you still owe to them. Read this article and guarantee accurate medical coding.
CMS's novel Comprehensive Error Rate Testing (CERT) results, which were out in November, explain that practices in fact made fewer errors in 2010 than in the preceding year. Maximum of the errors were revealed as overpayments—implying that CMS recognized $33.2 billion that went out to Medicare providers in mistake, and there are chances that MACs will be asking for much of that money back, if they haven't by now. Furthermore, CMS noted that it still owes $1.1 billion to providers who were underpaid in 2010.
To generate the CERT report, CMS revised 30,965 Part B claims, together with claims from Part A and DME, as per the "Medicare Fee-for-Service 2010 Improper Payment Report." Auditors then pored over the claims to decide which had no documentation, inadequate documentation, incorrect medical coding, or was a medically unnecessary service.
Documentation: Part B practices were the complete worst of the provider types as far as documentation was concerned, with a 2.1 percent error rate in the "insufficient documentation" category, greater than both Part A and DME providers.
Warning: In case a reviewer reviews your claim and discovers only a listing of the CPT® and ICD-9 codes that you reported, you have not proven medical necessity for the service, or even established that you in reality saw the patient. In these circumstances, the MAC could request the whole payment back.
Incorrect medical coding: Part B providers also rated the maximum among incorrect medical coding errors, with a 0.8 percent error rate, which topped the Part A and DME rates. Once more, not all of these errors reflected overpayments to practices--in few cases, doctors in reality shorted themselves by coding erroneously.
Avoid These Top 5 Physician Documentation Errors To Ensure Accurate Medical Coding
CMS found that physicians inappropriately billed $6.22 billion in claims that were later found to have inadequate documentation. In case you want to evade that type of error--which will lead to inaccurate medical coding--check out the top five errors:
1. No signature. Medicare needs that the author of a note validates it with a handwritten or electronic signature, however found that $1.3 billion worth of claims in reality had no signature at all.
2. Several errors. CMS noted that it inappropriately paid $1.1 billion on claims that had numerous dissimilar types of documentation errors.
3. Documentation does not go with code billed. "If it wasn't documented, it wasn't done." Medicare reviewers wholeheartedly agree with this sentiment, and said that physicians may have billed a particular code to the MAC, however the documentation didn't support it, causing $0.9 billion in errors in this category.
4. Effective physician order missing. Many services need a physician order. CMS discovered that the order was absent in $0.7 billion worth of claims.
5. Illegible identifier. In case a physician's signature is illegible or missing, CMS will give the provider an opportunity to attest to his signature. But, if the doctor does not return the attestation, the practice has to return the money it collected for the visit. CMS discovered $0.7 billion worth of errors in this category in 2010.
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