Unit 3 DB - take place because it would be so obvious,...

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Lorraine Huff Unit 3 DB September 11, 2009 Upcoding is defined as “a coding inconsistency that involves using a code for a procedure or diagnosis that is more complex than the actual procedure or diagnosis that results in higher reimbursement to the provider.” Basically, upcoding is charging more for the procedure than its actual cost for a profit to the practice. The use of upcoding in a medical practice is wrong. Upcoding is used by a practice to retain more of a profit. The benefits of the act are obvious for the providers; they receive more money than they are actually supposed to be receiving for a procedure that has not been administered. For example, a patient received a routine blood test for a cholesterol exam, but was charged for an angioplasty procedure caused by high cholesterol. Granted the example is a very large jump in price and would probably never
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Unformatted text preview: take place because it would be so obvious, however it would be the same for any procedure. Upcoding is a form of stealing from the insurance companies and Medicare. Regardless of the amount of profit that the practice makes, upcoding should not be a form of coding that should be used in any facility. Upcoding can be thought of as one main culprit of why health insurance costs for the consumers is so high. If Medicare and the insurance companies are paying more for procedures than they are supposed to be paying, they will in turn charge more in premiums for their customers. This is only the moral view of upcoding. The practicality of upcoding is that there are serious penalties and fines for anyone caught upcoding. References Encyclo. (2007, 15 October). Upcoding . Retrieved September 11, 2009, from Encyclo.co.uk: http://www.encyclo.co.uk/define/Upcoding...
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This note was uploaded on 01/18/2012 for the course FIN 456 taught by Professor Jinhall during the Spring '10 term at American InterContinental University.

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Unit 3 DB - take place because it would be so obvious,...

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