I'm afraid I don't share the same rosy outlook as some of our peer posters. From the time I spent on the payer side and continued involvement I have with those types of assignments, abuse is pretty common.
In many instances of abuse, providers are not staffing their offices with certified coders, hospitals develop internal policies that permit them to "DRG creep" by utilizing off-limit source documents and making assumptions on their coding. Too, billing departments and A/R are more concerned about "getting the billed paid" than whether or not that bill is correct. This makes it extremely difficult for payers. Daily they receive claims from providers who have no internal structure or audit that monitors the accuracy of their E/M levels, much less the more complex services. What is placed on the charge ticket goes to the bill.
I'm sorry, there is no wonder government payers have increased their scrutiny of claims. There are some serious coding and billing quality issues out there and it seems the only way to motivate providers and organizations is by using every resource available to identify errors, kick those claims back and recoup any overpaid or improperly paid monies. Complacency, laxity and ignorance are the drivers of most of this. Greed and criminal activity are another discussion.
Kevin B. Shields, RHIT, CPCO, CCS, CPC, COC, CCS-P, CPC-P, CPC-I