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

Info icon This preview shows pages 1–2. Sign up to view the full content.

View Full Document Right Arrow Icon
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
Image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Image of page 2
This is the end of the preview. Sign up to access the rest of the document.

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...
View Full Document

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern