OIG Report: Documentation Coding Errors Costing Medicare Billions

According to a new OIG report, documentation coding errors related to routine patient evaluation and management (E/M) visits are costing Medicare billions of dollars in improper payments a year. The investigation found that nearly $7 billion dollars in improper payments were made in 2010 alone. Most of the losses were the due to bills that were incorrectly coded and/or lacking documentation; 42% of claims for E/M services in 2010 were incorrectly coded and 19% lacked proper documentation. However, only about 4% of the visits analyzed were for initial or subsequent skilled nursing care-most of the claims were for “established patient office/outpatient visits.”

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3 thoughts on “OIG Report: Documentation Coding Errors Costing Medicare Billions

  1. Pingback: Monday Morning Recap | hmsabc

  2. In your experience, how much of the E &M coding challenge is related to EHRs that do not support physician workflows? Earlier this week I posted a piece discussing the importance of understanding physician workflows for established patient office visits. It contains a link to a March 2014 U.S. Department of Commerce study that is a real eye-opener. A group of physicians helped construct a process flow map of the established patient office visit.


    • Hi Harry, thank you for your question. From our experience, we’re not seeing that E&M coding is much of a challenge in relation to EHRs. However, we can see where it would be a challenge if EHRs did not support physician workflows. We believe physician practices that use EHRs need to effectively implement them to be successful. It is especially important that physicians plan ahead and design EHR workflows that will increase productivity and efficiency of their practice. Most importantly, physicians need to work with staff to take into account every detail, including which forms are used for documentation-to prevent any confusion during the go-live process. Physicians should also work with their EHR vendor to get a customized solutions/progress note template if necessary since each practice/workflow is different. If all these steps are taken, there should not be much of an E&M coding challenge.

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