6 Reasons Why the OIG is Looking at Your E/M Services

Evaluation and management (E/M) services are “visits performed by doctors to assess and manage a beneficiary's health,” according to the OIG’s website. For billing purposes it requires the process of translating physician-patient encounters into CPT codes. Medicare pays billions for E/M services but CMS has revealed overpayments and massive errors in coding and/or a complete lack of documentation. Therefore, the OIG is looking at your E/M services.

For more details on this topic, you can download our free eBrief, Is "The OIG Looking At Your E/M Services?".

The 6 Reasons Why the OIG Is Looking at Your E/M Services:

1. In 2010, Medicare paid $32.3 billion for E/M services. This represented almost 30% of Medicare Part B payments for that year. 
2. The OIG studied physician billing patterns from 2001 through 2010 with data from the CERT program to analyze errors related to E/M services. The OIG discovered that physicians increased their coding and billing of higher level codes for E/M services in all visit types.
3. In the 2011 CERT report, CMS found that E/M services made up a large proportion of Part B improper payments. And were 50% more likely to be paid in error than other Part B services.
4. Improper payments most often resulted from E/M coding errors or incorrect documentation. 
5. In 2010, Medicare paid $6.7 billion inappropriately for E/M service related claims that were incorrectly coded and/or lacking documentation.
6. Which represented 21% of Medicare payments for E/M services that year. 
7. In 2010, the OIG found that 42% of claims for E/M services were erroneously coded. 19% of which lacked documentation. 

With so many errors being identified and billions of Medicare dollars on the line, it should be no surprise the OIG is clamping down on E/M documentation.

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