You are Losing Money by Undercoding and the Government Thanks You

August 17, 2018

By undercoding evaluation and management visits for established patients, $369.3 million in revenue was left on the table in 2017 according to the Annual CMS Comprehensive Error Rate Testing Report.

Documentation reviewed revealed that the code billed did not substantiate the record. This means that you are recording accurately in the patient’s record but not on your charge slips.

When recording your codes, ask yourself:

  1. Are you reporting secondary and tertiary diagnosis on your claims after discussing them with patients? These may not be the reason for the visit but may play into your medical decision making.
  2.  Has the social history changed? This can certainly affect patient’s well-being, increasing anxiety, blood pressure etc.
  3. Did you check other symptoms after listening to patient’s complaints?

None of the above may be the reason for patient visit but are addressed in the visit, allowing you to be reimbursed if coded correctly.

The guidelines for Evaluation and Management coding are due to see some changes in the coming year. Rumor has it that the requirements for level coding will be lessoned. This should help keep some of these bucks out of the Government coffers and into yours.

If you are unsure you are properly coding your claims, please contact NEARM for an evaluation and audit. We would love to help!