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Audit (A-01-09-00509)

Review of Emergency Department Procedure Codes Billed by Cape Cod Emergency Associates

Executive Summary

Claims billed by Cape Cod Emergency Associates (CCEA) for emergency department services did not always meet certain Medicare requirements. Specifically, 42 of the 100 claims that we reviewed were for services that were either incorrectly coded (39 claims) or incorrectly billed (3 claims). The incorrectly coded claims resulted in overpayments and underpayments to CCEA that, when netted, were immaterial, and the incorrectly billed claims resulted in $235 in overpayments to CCEA.

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