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American Association of Hip and Knee Surgeons

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OIG Report Estimates Improper Payments for E/M Services Cost Medicare Billions

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  • OIG Report Estimates Improper Payments for E/M Services Cost Medicare Billions

The HHS Office of Inspector General (OIG) estimates that Medicare inappropriately paid $6.7 billion for E/M services that were upcoded, downcoded, and/or lacked documentation in 2010. In response, CMS states that it will continue to issue education documents on E/M services and will collaborate with contractors to respond to questions and clarify policies when inconsistencies in billing practices arise. CMS rejected the OIG recommendation that they prioritize their medical review strategies to focus medical record reviews of E/M services on claims from “high-coding physicians,” noting that the average overpayment was $33 per claim and previous efforts resulted in a negative return on investment. Read the full report from OIG here.

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