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downcoding |
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downcoding (doun´kō´ding), n a practice of third-party payers in which the benefits code has been changed to a less complex or lower cost procedure than was reported. How to thank TFD for its existence? Tell a friend about us, add a link to this page, add the site to iGoogle, or visit webmaster's page for free fun content. |
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3) A study from the Department of Emergency Medicine at Maine Medical Center in Portland found that the use of pocket-sized dictation templates along with Continuous Quality Improvement methodology not only increased compliance with guidelines but also decreased the downcoding of charts and increased billable records. They also claimed that making payments on a basis other than the medical necessity definition contained in their agreements with the insurers constituted a pattern of racketeering activity and that failing to pay their claims, or the downcoding of their claims according to a new standard other than medical necessity, was a breach of contract. Ample evidence of facility confusion has surfaced over the years, most particularly in the recent OIG study disclosing a mishmash of PPS upcoding and downcoding without apparent reason. |
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