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News: OIG finds E/M targets

CDI Strategies, June 5, 2014

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Physician evaluation and management (E/M) payments cost Medicare $32.3 billion in 2010—about 30% of all Part B payments that year—and of that amount, about $6.7 billion were incorrectly coded or documented, according to an Office of the Inspector General report released in May.

The OIG found that claims for E/M services billed for by high-coding physicians were more likely to be incorrectly coded or insufficiently documented than those billed for by other physicians, the report states.

“Even though Medicare payment rates for individual E/M services are small (about $100 on average), 70 million E/M services were billed for by physicians in 2010 and accounted for nearly 30% percent ($32.3 billion of $110 billion) of Part B payments that year,” the OIG stated. It urged CMS educate physicians on coding and documentation requirements for E/M services and the components used to determine E/M levels.

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