{"id":1840,"date":"2024-09-15T15:17:28","date_gmt":"2024-09-15T15:17:28","guid":{"rendered":"https:\/\/zenmedinc.com\/blog\/?p=1840"},"modified":"2024-12-07T13:07:10","modified_gmt":"2024-12-07T13:07:10","slug":"medicare-fee-for-service-errors","status":"publish","type":"post","link":"https:\/\/zenmedinc.com\/blog\/medicare-fee-for-service-errors\/","title":{"rendered":"COMPLIANCE CHECK: The 2023 Medicare Fee-for-Service Errors &amp; Improper Payment Report and why you should be concerned"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"1840\" class=\"elementor elementor-1840\">\n\t\t\t\t<div class=\"elementor-element elementor-element-08a0601 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"08a0601\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-01f4a4d elementor-widget elementor-widget-text-editor\" data-id=\"01f4a4d\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">Well, here we are at the beginning of the fourth quarter of 2024 and CMS has graced us with their annual as I call it \u201cThe Come to Jesus Report\u201d, as it highlights ALL the Coding, Billing, Documentation errors, and Service Types, across all states. It is a good read, and I strongly recommend it to all Practice Administrators, Directors of RCM, Coding, Billing, Auditing, and Compliance, at the very least. It\u2019s a good time to dust off the old Compliance manual (which hopefully you have) and check in on how your providers are doing and the coding, billing, and auditing teams. <\/span><\/span><\/p><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">This article will focus on Evaluation and Management codes and touch on some others that are part of the \u201cTop Five\u201d on the report, which will provide insight into what codes landed as the most frequently billed and which codes had the most errors of 2023. The Centers for Medicare (CMS) measures the Medicare Fee For Service (FFS) improper payment rate through the CERT program and the 2023 Medicare FFS improper payment rate included claims submitted during the 12 months from July 1, 2021, through June 30, 2022. <\/span><\/span><\/p><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">To break down this process the folks at CMS use a sampling process for CERT that follows a service level stratification plan into what is called a \u201cuniverse\u201d and approximately 100 claims are sampled in the universe per claim type and are then reviewed, which leads to an improper payment rate, which ultimately leads to the total payments made. Below is the overall Accuracy Rate and Improper Payment Rate for this year\u2019s report:<\/span><\/span><\/p><ul><li><span style=\"font-family: Calibri, serif;\"><span style=\"font-size: small;\"><span style=\"color: #000000;\">Roughly 7.38% were deemed Improper Payments, which means a 92.62% Accuracy Rate. CMS requires 95% accuracy overall for Coding and Billing of submitted claims.<\/span> <\/span><\/span><\/li><\/ul><p><img fetchpriority=\"high\" decoding=\"async\" class=\"aligncenter wp-image-1845 size-full\" src=\"https:\/\/zenmedinc.com\/blog\/wp-content\/uploads\/2024\/09\/errors.jpg\" alt=\"improper payment rate\" width=\"570\" height=\"352\" \/><\/p><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">Now we must factor in that due to the documentation requirements that changed in 2021 (which were supposed to un-burden providers). Calendar year (CY), 2022 was the second year that providers were supposed to be actively utilizing the new E&amp;M guidelines from the AMA\/CPT\/CMS, which are now based on either Time or Medical Decision Making (MDM). This impacted many clinicians across a wide range of specialties. <\/span><\/span><\/p><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">The billed level of service will also vary by specialty as the patient demographic varies. An Oncologist who sees complicated cases will tend to bill higher E&amp;M visits versus say a pediatrician, who does not see the same type of cases. That does not mean a pediatrician wouldn\u2019t be justified in billing a higher-level E&amp;M, if the MDM documentation supports it or if they billed based on time.<\/span><\/span><\/p><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">Other coding issues that can cause incorrect coding errors are if a provider reports a code that is higher or lower than what the documentation supports. For example a provider spent and documented 20 minutes for an established patient with COPD and 99215 is submitted, it would be considered up-coded, as 99215 requires at minimum, 40 minutes of total time with the patient to get credit for the level five visit. A payer would down-code this if they caught it on the front end, to a 99213 and record it as a coding error. Additionally, they could also ask for a refund or offset of payment, in a post-payment review, if it was missed and paid out on the front end. <\/span><\/span><\/p><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">So what are the Top Five Common Causes of Improper Payments you ask? CMS has kindly put them into some terrific graphs and as you can see below, the Top Five are as follows:<\/span><\/span><\/p><ul><li><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">Insufficient Documentation led the pack with an astounding 62.8%<\/span><\/span><\/p><\/li><li><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">Medical Necessity came in a strong second with 15% <\/span><\/span><\/p><\/li><li><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">Incorrect Coding came in with 11.6%<\/span><\/span><\/p><\/li><li><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">My favorite \u201cother\u201d at 6.9%<\/span><\/span><\/p><\/li><li><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">Last but definitely not least is No Documentation with 3.7%<\/span><\/span><\/p><\/li><\/ul><p><img decoding=\"async\" class=\"aligncenter wp-image-1846 size-full\" src=\"https:\/\/zenmedinc.com\/blog\/wp-content\/uploads\/2024\/09\/improper-payments.jpg\" alt=\"\" width=\"638\" height=\"632\" \/><\/p><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\"><b>Ensure that all claims are bulletproof with concise and supportive documentation<\/b><\/span><\/span><\/p><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">When I educate providers, one of the first things I discuss is how to bulletproof the documentation. In other words, if you were called to the witness stand, would the visit note hold up or would you go down flames? Unfortunately, this year\u2019s reports appear that many would go down in flames and the lesson here is that we can use this information to improve. Let&#8217;s take a look at the data for CMS Part B service codes and see where exactly improvement is most needed as we head into 2025.<\/span><\/span><\/p><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\"><b>2023 E&amp;M\/CPT Code Report Stats: <\/b><\/span><\/span><\/p><ul><li><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">The most reported Evaluation &amp; Management codes for outpatient\/office visits were 99214 for established patients and 99204 for new patients.<\/span><\/span><\/p><\/li><li><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">Most reported Part B service coding errors for office visits landed with insufficient documentation, lab tests, and minor procedures.<\/span><\/span><\/p><\/li><\/ul><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\"><b>99214 &amp; 99204 Focal Points in most CMS Audits<\/b><\/span><\/span><\/p><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">The most recent Centers for Medicare &amp; Medicaid Services (CMS) utilization data (from FY 2022) indicate that Medicare Part B paid for more instances of 99214 (Office or other outpatient visits for the evaluation and management of an established patient, which requires a medically appropriate history and\/or examination and a moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded) than any other outpatient office visit codes. 99204, Office or other outpatient visits for the evaluation and management of a new patient, which requires a medically appropriate history and\/or examination and a moderate level of medical decision-making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded) was the most frequently billed.<\/span><\/span><\/p><p><img decoding=\"async\" class=\"aligncenter wp-image-1847 size-full\" src=\"https:\/\/zenmedinc.com\/blog\/wp-content\/uploads\/2024\/09\/improper-payments-2.jpg\" alt=\"\" width=\"834\" height=\"702\" \/><\/p><p>\u00a0<\/p><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\"><b>CLOSING THOUGHTS <\/b><\/span><\/span><\/p><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">When you consider that Medicare allowed 98.5 million claims for 99214 in 2022, and 12.3 million claims for 99204 in 2022, it is easy to see why these two E&amp;M codes are targeted in most CMS\/government audits. Additionally, E&amp;M Codes 99213\/99203 came in close behind 99214\/99204 with 73.6 million paid claims for 99213 and 99203 following up with 9.6 million claims. One of the key differences is that Level 3 E&amp;Ms \u2013 99213\/99203 are often under-coded vs 99214\/99204 being up-coded and for certain specialties, once they see a new patient, i.e., either 99203 or 99204, they can\u2019t bill for another new patient visit for the same patient, until three (3) years have passed, from the initial new patient visit. <\/span><\/span><\/p><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\"><b>TAKEAWAYS:<\/b><\/span><\/span><\/p><ul><li><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">Bulletproof Documentation with Providers &#8211; Ongoing<\/span><\/span><\/p><\/li><li><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">Perform ongoing Coding and Billing Reviews<\/span><\/span><\/p><\/li><li><p><span style=\"color: #000000;\"><span style=\"font-family: Calibri, serif;\"><span style=\"font-size: small;\">Check the CERT reports on your Medicare Administrative Contractor\u2019s MAC\u2019s website &#8211;<\/span><\/span> <span style=\"color: #0000ff;\"><u><a style=\"color: #0000ff;\" href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/medicare-administrative-contractors-macs\/who-are-macs#MapsandLists\"><span style=\"font-family: Calibri, serif;\"><span style=\"font-size: small;\">https:\/\/www.cms.gov\/medicare\/coding-billing\/medicare-administrative-contractors-macs\/who-are-macs#MapsandLists<\/span><\/span><\/a><\/u><\/span><\/span><\/p><\/li><li><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">Perform Compliance Plan Quarterly<\/span><\/span><\/p><\/li><li><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">Review Payer Denials and Requests &#8211; Ongoing<\/span><\/span><\/p><\/li><\/ul><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\">Happy Coding!<\/span><\/span><\/p><p>\u00a0<\/p><p><span style=\"font-family: Calibri, serif; color: #000000;\"><span style=\"font-size: small;\"><b>RESOURCES:<\/b><\/span><\/span><\/p><ul><li><p><span style=\"color: #0000ff;\"><u><a style=\"color: #0000ff;\" href=\"https:\/\/www.medcentral.com\/coding-reimbursement\/the-most-billed-and-most-error-prone-codes-of-2023\"><span style=\"font-family: Calibri, serif;\"><span style=\"font-size: small;\">https:\/\/www.medcentral.com\/coding-reimbursement\/the-most-billed-and-most-error-prone-codes-of-2023<\/span><\/span><\/a><\/u><\/span><\/p><\/li><li><p><span style=\"color: #0000ff;\"><u><a style=\"color: #0000ff;\" href=\"https:\/\/www.cms.gov\/files\/document\/2023medicarefee-servicesupplementalimproperpaymentdatapdf.pdf\"><span style=\"font-family: Calibri, serif;\"><span style=\"font-size: small;\">https:\/\/www.cms.gov\/files\/document\/2023medicarefee-servicesupplementalimproperpaymentdatapdf.pdf<\/span><\/span><\/a><\/u><\/span><\/p><\/li><li><p><span style=\"color: #0000ff;\"><u><a style=\"color: #0000ff;\" href=\"https:\/\/www.cms.gov\/data-research\/statistics-trends-and-reports\/medicare-fee-for-service-parts-a-b\"><span style=\"font-family: Calibri, serif;\"><span style=\"font-size: small;\">https:\/\/www.cms.gov\/data-research\/statistics-trends-and-reports\/medicare-fee-for-service-parts-a-b<\/span><\/span><\/a><\/u><\/span><\/p><\/li><li><p><span style=\"color: #0000ff;\"><u><a style=\"color: #0000ff;\" href=\"https:\/\/www.cms.gov\/files\/document\/2022-medicare-fee-service-supplemental-improper-payment-data.pdf\"><span style=\"font-family: Calibri, serif;\"><span style=\"font-size: small;\">https:\/\/www.cms.gov\/files\/document\/2022-medicare-fee-service-supplemental-improper-payment-data.pdf<\/span><\/span><\/a><\/u><\/span><\/p><\/li><li><p><span style=\"color: #0000ff;\"><u><a style=\"color: #0000ff;\" href=\"https:\/\/www.medcentral.com\/endocrinology\/diabetes\"><span style=\"font-family: Calibri, serif;\"><span style=\"font-size: small;\">https:\/\/www.medcentral.com\/endocrinology\/diabetes<\/span><\/span><\/a><\/u><\/span><\/p><\/li><li><p><span style=\"color: #0000ff;\"><u><a style=\"color: #0000ff;\" href=\"https:\/\/www.cms.gov\/files\/document\/2023medicarefee-servicesupplementalimproperpaymentdatapdf.pdf\"><span style=\"font-family: Calibri, serif;\"><span style=\"font-size: small;\">https:\/\/www.cms.gov\/files\/document\/2023medicarefee-servicesupplementalimproperpaymentdatapdf.pdf<\/span><\/span><\/a><\/u><\/span><\/p><\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Well, here we are at the beginning of the fourth quarter of 2024 and CMS has graced us with their annual as I call it \u201cThe Come to Jesus Report\u201d, as it highlights ALL the Coding, Billing, Documentation errors, and Service Types, across all states. It is a good read,<\/p>\n","protected":false},"author":2,"featured_media":1843,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[15],"tags":[44,45,42],"class_list":["post-1840","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical-billing","tag-evaluation-and-management-codes","tag-improper-payment-rate","tag-medicare-fee-for-service"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>COMPLIANCE CHECK: The 2023 Medicare Fee-for-Service Errors &amp; Improper Payment Report and why you should be concerned - ZenMed Solutions Inc<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/zenmedinc.com\/blog\/medicare-fee-for-service-errors\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"COMPLIANCE CHECK: The 2023 Medicare Fee-for-Service Errors &amp; Improper Payment Report and why you should be concerned - ZenMed Solutions Inc\" \/>\n<meta property=\"og:description\" content=\"Well, here we are at the beginning of the fourth quarter of 2024 and CMS has graced us with their annual as I call it \u201cThe Come to Jesus Report\u201d, as it highlights ALL the Coding, Billing, Documentation errors, and Service Types, across all states. 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