Medical Billing and Coding Healthcare Blog

The Centers for Medicare & Medicaid Services (CMS) has issued a reminder to providers concerning billing the correct level of service for evaluation and management (E/M).

CMS notes that a 2012 study report from the Office of the Inspector General indicated that a number of physicians increased their billing of higher level, more complex and expensive E/M codes. Many providers submit claims coded at a higher or lower level than the medical record documentation supports.

CMS advises providers to use the following resources to assist in their efforts to bill correctly for E/M services:

On October 1, 2016, the Centers for Medicare & Medicaid Services (CMS) will end its year-long ICD-10 "grace period."

This Medicare ICD-10 flexibilities period was instituted to help ease the transition to the new coding requirements adopted last year.

On October 1, 2016, all diagnosis coding must be to the correct level of specificity. Claims not coded correctly may not be processed and could receive an audit.

In August, CMS published new frequently asked questions and responses pertaining to guidance regarding ICD-10 flexibilities. In this FAQ, CMS stated it would not extend ICD-10 flexibilities beyond October 1, 2016.

For assistance with ICD-10, use PGM's ICD-10 coding tools.

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