upcoding

upcoding

Medicare A fraudulent practice in which provider services are billed for higher CPT procedure codes than were actually performed, resulting in a higher payment by Medicare or 3rd-party payors. See Coding, CPT coding, Health care fraud, HIPPA Act, Prompt payment law, Rebundling, Unbundling. Cf Downcoding.
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This often includes inflated medical bills, charges for services not rendered and deceptive billing practices such as upcoding, unbundling or modifier abuse.
The cartel connection: Linking insurance fraud, drug cartels and terrorism
Other false claims and provider billing errors include unbundling, double billing, and upcoding.
Time for a cure? This homespun remedy for healthcare cost inflammation could help reduce errors and fraudulent billings
Some physicians responded by upcoding --claiming greater complexity in patient encounters than was in fact the case--and fraud investigations at some centers were under way.
Doctored: the disillusionment of an American physician: an interview with Sandeep Jauhar
However, if providers are not diligent in reviewing the information that often is quickly pasted in, the feature can be a vehicle for introducing errors that could result in fraud charges and possible fines for upcoding, for example.
Be wary of copy-and-paste EHR mistakes while it's a snap to paste information, it can also put a facility at risk for fraud
Upon taking the bait, physicians find themselves targeted by insurers, Medicare recovery audit contractors (RACs), and even prosecutors, who accuse them of fraudulent upcoding.
Dialectic of deceit
Those include an aggressive plan to compel more physicians forward to adopt EHRs, improving interoperability via the Blue Button Initiative and other means, and cracking down on potential "gaming of the system" through EHR-facilitated upcoding.
Mostashari, Tavenner reference New York Times coverage at HIMSS13 events: federal officials emphasize their resolve to fully automate healthcare delivery
Physicians can be challenged for overbilling, underbilling, upcoding, using the wrong code, and the provision of care not deemed medically reasonable and necessary because it is more care than should have been provided, less care than
Mandating mediocre medicine
One of the most common examples of fraud is upcoding, where a medical provider bills the insurance provider for a similar but more expensive patient procedure to maximise payout.
Misuse of insurance pushing up premiums by 20%
But now the government is also warning providers not to abuse the technology by engaging in fraud through either improper upcoding or the cloning of medical records.
Feds cracking down on EHR upcoding
The Center for Public Integrity recently concluded a 21-month investigation into the higher Medicare billing that has emerged over the last decade, including upcoding through the use of EHRs.
Cracking down on EHR upcoding: the blog of clinical psychiatry news digital network
Third, optimal coding of comorbid condition required in risk adjustment may have been gamed through upcoding, thus leading to observed outcomes that are better than predicted, he suggested.
Use of PCI drops with reporting of outcomes
Leap covers a variety of health care fraud crimes such as: kickbacks, illicit referrals, overcharging, upcoding, insurance scams, short-pilling, and more.
Phantom billing, fake prescriptions, and the high cost of medicine; health care fraud and what to do about it

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