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To get an idea of the scope of undercoding, you need look no further than the Centers for Medicare & Medicaid Services (CMS). In the late 1990s, the CMS established the comprehensive error rate testing (CERT) program, which audits more than 100,000 claims each year to determine how many Medicare payments were incorrect.

You’ve no doubt seen the results of this program in news stories that highlight how much money Medicare is overpaying physicians and hospitals. But the program also tracks underpayments, and CERT analyses consistently find that many E&M services are undercoded. Not surprisingly, codes that hospitalists use are on that list.

While national studies estimate that physicians lose up to 9% of the revenue they should receive because of undercoding, one hospitalist practice was taking a 20% hit in reimbursement for subsequent care days because the physicians rarely used the highest level of coding.

From:
http://www.todayshospitalist.com/index.php?b=articles_read&cnt=859

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