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55% of E&M Claims Have Mistakes. Here’s How to Avoid It

Studies show:

Nearly 80 percent of medical claims that providers submit to payers have mistakes. Practices incorrectly code approximately 55 percent of evaluation and management claims.

This is an alarming number, and if healthcare organizations lack clear and concise policies and procedures in this area, it will only continue. 

Leaders ask yourself:

When was the last time I performed an internal audit?

If you can’t answer this question quickly, maybe it is time to ensure your practice is safe by implementing an audit program that:

Minimizes billing and coding mistakes.

Auditing is one of the seven elements in the OIG Federal Register 2000. They state a baseline audit is helpful to see how well your staff is following the regulations. 

Audits should be completed annually, and I recommend you hire a consultant. Consultants will help you identify risks and improve the organization’s operations.  It’s worth the cost.

Remember, the OIG is a big fan of consistency.

If you do the work on the front end, you will reduce the risk of being placed on the exclusion list, subject to penalties and investigations by the federal or state government.


*The opinions and observations from Joi Sherrod/group are not a promise to exempt your practice from fines and penalties.  Research, modify and tailor the advice to fit your specialty.

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Joi Sherrod, MPH, CPC, CPCO
Joi Sherrod, MPH, CPC, CPCO
Joi is an educator and owner of JNC Healthcare Compliance Group. After working for distinguished academic teaching hospitals and clinics, she is passionate about helping medical, dental, and behavioral health practices rethink healthcare compliance one trend at a time. Contact Joi at