Medicare Loses Billions to Billing Errors

Abstract

Medicare continues to improperly pay billions to physicians because of incorrectly billed claims. While inpatient hospital claims have recently (2017-2018) seen a reduction in improper payments, improper payments for physician outpatient services, particularly evaluation and management services (E/M), continue to see little or no improvement. Opinions vary on the causes of these billing errors and consequently on the appropriate countermeasures. Despite this national crisis, to date, no strategies have proven to improve billing accuracy for evaluation and management services. This research examines the existing literature to explore theories and constructs that explain causal factors of evaluation and management billing errors and to illuminate gaps in the research which if explored, may result in potential strategies for improving billing accuracy.

Keywords: Evaluation and management, coding accuracy, documentation, billing errors, fraud, medical