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Government Examines Coding Trends for Medicare Evaluation and Management Services
The Office of Inspector General of the Department of Health and Human Services (“OIG”) published a report in May 2012 finding that physicians have “steadily increased” code levels billed for evaluation and management (E/M) services between 2001 through 2010. The OIG used claims data to analyze and identify physicians who consistently billed higher level E/M codes during that time period. The OIG concluded that the use of higher level codes resulted in Part B Medicare payments increasing by 43 percent over those years.
The report indicates that, although the average billing level increased across the board, nearly 1,700 indentified physicians consistently billed at the two highest levels for E/M services within a specific visit type at least 95 percent of the time. These higher-billing level physicians practice in nearly all states, and treat patients within the same practice specialties as the broader percentage of physicians providing E/M services.
The OIG did not determine whether the physicians actually billed appropriately, but recommended that CMS review physicians who bill higher level E/M codes for “appropriate action.” Increased scrutiny into claims data and sophisticated technology could lead to focused reviews of provider data by carriers, Medicare program integrity auditors, and the OIG.