By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    An Expert’s Guide To Building and Improving Endurance
    June 30, 2022
    medical assistants
    What Do Medical Assistants Do On a Day to Day Basis?
    April 5, 2022
    superfoods to help with prostate health
    10 Healthy Foods That Can Help Protect Your Prostate
    August 29, 2022
    Latest News
    5 Steps to a Promising Career as a Healthcare Administrator
    August 3, 2025
    Why Custom Telemedicine Apps Outperform Off‑the‑Shelf Solutions
    July 20, 2025
    How Probate Planning Shapes the Future of Your Estate and Family Care
    July 17, 2025
    Beyond Nutrition: Everyday Foods That Support Whole-Body Health
    June 15, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    healthcare cost crisis
    What If the Health Care Cost Crisis Solves Itself?
    May 11, 2013
    Do You Need Life Insurance? What Does It Cover?
    December 23, 2022
    HIE metal plans
    The Four “Metal Plans” of Health Insurance Exchanges
    May 28, 2013
    Latest News
    How IT and Marketing Teams Can Collaborate to Protect Patient Trust
    July 17, 2025
    How Health Choices and Legal Actions Intersect After an Injury
    July 17, 2025
    How communities and healthcare providers can address slip and fall injuries with legal awareness
    July 17, 2025
    Let Your Lawyer Handle the Work Before You Pay Medical Costs
    July 6, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: OIG Looking at Mis-Coding of E and M Claims
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Business > Finance > OIG Looking at Mis-Coding of E and M Claims
BusinessFinanceHospital AdministrationMedical RecordsPolicy & Law

OIG Looking at Mis-Coding of E and M Claims

Andy Salmen
Andy Salmen
Share
3 Min Read
SHARE

OIG_Study_and_SurveyA recently released study from the Office of the Inspector General (OIG) of the US Department of Health and Human Services focused on improper Medicare payments for evaluation and management (E/M) services.

OIG_Study_and_SurveyA recently released study from the Office of the Inspector General (OIG) of the US Department of Health and Human Services focused on improper Medicare payments for evaluation and management (E/M) services. E/M services include visits to non-physician and physician practitioners that aim to manage and assess a patient’s health.  In 2010 Medicare paid $32.3 billion for all E/M services which made up almost 30% of all Part B payments for the year. 

The OIG completed this study in order to gather more information about E/M services, the billing of higher level codes, and the possibility of improper payments.  In 2012 the OIG released a previous report that indicated physicians had increased their billing of higher level codes for E/M services from 2001 to 2010.  This report also discovered that there was a higher likelihood of billing errors than in other services provided under Medicare Part B.  

More Read

online communities and disclosure
Articles about Disclosure in Online Communities
Advance Practice Nurse Led Clinics – Coming to Your Medical Neighborhood Soon?
High Quality, Low Cost HealthCare Video Interview Series: David Wong and SnapHealth
The Impact of Global Health Crises on Personal Finance
What’s Wrong with Pay for Performance?

In order to complete this study OIG conducted a national record review of random samples from Part B claims. These samples targeted E/M services from 2010 and included claims from “high coding” physicians and those from other physicians.  A “high coding” physician is one that routinely bills for higher level codes including E/M services.  The OIG utilized the expertise of certified professional coders to determine whether a claim was correctly coded, included a documented need for the higher level E/M service, and whether or not sufficient documentation accompanied the claim. 

The OIG discovered that Medicare paid $6.7 billion in 2010 for inappropriate E/M services.  These claims either lacked sufficient documentation or were incorrectly coded.  This $6.7 billion made up nearly 21% of all E/M Medicare payments for 2010.  Specifically, 19% lacked the required documentation and 42% were coded incorrectly.  Claims that included incorrect codes represented both upcoding for higher level claims and downcoding to lower levels than warranted.

Based on this study the OIG developed a series of recommendations for the Centers for Medicare Services (CMS):

  1. CMS should educate physicians on appropriate coding and required documentation standards for all E/M services.
  2. CMS needs to continue encouraging contractors to review claims submitted for E/M services by high-coding physicians. 
  3. CMS should continue follow up on claims that were reimbursed in error for E/M services.

Understanding this OIG study and the subsequent report is essential for orthopedic surgeons in private practice. Your practice’s billing and coding procedures are vital to ensuring you receive the proper levels of reimbursement. 

Image: tiramisustudio/freedigitalphotos.net

Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

technology in medical research
The Tools Helping Medical Researchers See the Full Picture
News Technology
August 3, 2025
5 Steps to a Promising Career as a Healthcare Administrator
5 Steps to a Promising Career as a Healthcare Administrator
Health
July 31, 2025
holistic dental
Holistic Dentist Services Are Natural and Safe
Dental health Specialties
July 28, 2025
botox certification
Help Improve People’s Skin Health Via Botox Certification
Skin Specialties
July 22, 2025

You Might also Like

obamacare an covered california
BusinessFinanceHealth ReformPolicy & LawPublic Health

Obamacare and Reimbursement Rates to Providers

December 11, 2013
A doctor in scrubs holding a computer
BusinesseHealthSocial Media

How to Manage the Online Reputation of Your Medical Practice

March 8, 2016

Transitioning To Electronic Health Records: From Financing To Implementation

January 12, 2016

2011 Cost of Long-Term Care Study Releases Findings

June 21, 2011
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?