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Billing Errors: This MAC’s Audit Finds That Some Practices Could Be Collecting More

Posted on 08. Jul, 2015 by in Provider News

Downcoding errors mean that these providers are selling themselves short.

When you hear that a MAC reviewed a practice’s documentation and found errors, you probably assume that the payer uncovered dozens of upcoded charges. But in some cases, the opposite may be also true. That’s the case with a recent CERT audit summary reported by Part B MAC WPS Medicare, which found a variety of errors including several cases where the practices could have billed higher E/M codes.

Downcoding Is Alive and Well

WPS Medicare recently released its Fourth Quarter 2014 CERT Error Summary, which reveals the documentation, coding and billing errors that the contractor uncovered during its most recent audit. Most of the errors were related to insufficient documentation, including situations where the physician signature or order was missing from a claim, as well as missing progress notes and dates of service.

Another 18 percent of errors that...

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