A random survey of claims by the Medicare Part B carrier in five states has uncovered average error rates of 50-90 percent for E/M codes, according to a report by Part B News.
TrailBlazer, the carrier in Colorado, New Mexico, Oklahoma, Texas and Virginia, said the most common cause was "documentation errors." TrailBlazer also cited some obvious errors, such as the reason for encounter was to receive lab results, which doesn't count as an E/M and also some not so obvious ones, such as that the frequency of E/Ms billed per beneficiary exceeded documented needs for management of stable, chronic conditions.
"I could see maybe 20 percent (error rate) or a little higher. But 90 percent I just haven't seen before," said Seth Canterbury, an education specialist for the University of Florida Jacksonville Physicians.
Read the Part B News report on coding.
Read more coverage on coding:
-RACs Starting to Audit Physicians' E/M Codes
-RACs' Upcoming Part B Audits Likely to Focus on Modifier -25 Usage
-CMS Issues Transmittal to Clarify Deleted Consultation Codes
TrailBlazer, the carrier in Colorado, New Mexico, Oklahoma, Texas and Virginia, said the most common cause was "documentation errors." TrailBlazer also cited some obvious errors, such as the reason for encounter was to receive lab results, which doesn't count as an E/M and also some not so obvious ones, such as that the frequency of E/Ms billed per beneficiary exceeded documented needs for management of stable, chronic conditions.
"I could see maybe 20 percent (error rate) or a little higher. But 90 percent I just haven't seen before," said Seth Canterbury, an education specialist for the University of Florida Jacksonville Physicians.
Read the Part B News report on coding.
Read more coverage on coding:
-RACs Starting to Audit Physicians' E/M Codes
-RACs' Upcoming Part B Audits Likely to Focus on Modifier -25 Usage
-CMS Issues Transmittal to Clarify Deleted Consultation Codes