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 on coding, billing and collections:
–Providers, Third-Party Billers Butt Heads Over Accountability for Claims Accuracy
–Medicare Carriers Properly Processing Surgery Center Claims With -PT Modifier
–Codes for Surgery Centers to Report A-C IOLs and Related Procedures, Services
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