It’s a compliance risk, and it deprives your physicians of proper payment. “Overcoding,” or reporting procedures and services not supported by the actual work performed (as described in provider documentation), is improper coding, and it’s a compliance risk. “Undercoding” — or failing to report the full extent of provided procedures or services — is an ...
In CMS
Oct 3rd, 2016
When it comes to audit results, most compliance experts, providers, and coders worry about “overcoding,” or reporting a service or procedure not sufficiently supported by documentation. Although overcoding is definitely a problem—and one that can get you into serious hot water—that doesn’t mean you’re making the right choice to “play it safe” by deliberately undercoding, ...
Jul 29th, 2015
By Nancy Clark, CPC, CPC-H, CPB, CPMA, CPC-I While recently reviewing claims, I noticed an area of “undercoding,” or coding for a lesser procedure than is documented in the medical record. Upon review, this particular issue also appears as a repeat offender of the Comprehensive Error Rate Testing (CERT) program on several Medicare Administrative Carriers’ ...
In Audit
Apr 4th, 2014
Question: I’m in need of written documentation to verify that “under coding” is a compliance risk, much like overcoding. Where can I find this? Answer: The Centers for Medicare & Medicaid Services (CMS), through its Medicare Learning Network, offers a  Fact Sheet detailing “Medicare Fraud and Abuse: Prevention, Detection, and Reporting.” Nothing in the document ...
Apr 1st, 2007
By Chris Fraizer, CPC, CPC-H, CPC-P Documentation no longer holds first place for claims rejection, according to the latest results of the Comprehensive Error Rate Testing (CERT) program of the Centers for Medicare and Medicaid Services (CMS). But the not so good news: Coding errors now hold that distinction (see accompanying table). “Coding errors are skyrocketing,” says Diana Lerro, BSN, RN, CPC-...