tci Medicare Compliance & Reimbursement - 2017 Issue 3

Compliance: Steer Clear of Upcoding to Duck the OIG's Reproach

Concise notes decrease the chance of billing errors. Perennially, the OIG ranks upcoding at the top of its Medicare abuse list. Not only does this common error cause financial strife, it also lands providers in hot water under the Federal Claims Act (FCA). Why It’s on the OIG Radar What is upcoding? Upcoding happens when a physician misuses a billing code with a higher reimbursement rate instead of a code for the level of service given. The reason the OIG continues to crack down on this practice is due to the heavy toll it brings to the improper...

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