tci Part B Insider - 2017 Issue 3

Compliance: Expect to Be on the OIG's Radar If You Rely Heavily on Upcoding to Make Ends Meet

Strong documentation will help with damage control and the FCA. When it comes to coding and billing, tipping the scalesin your favor will land your practice in hot water. Not only does this common error cause financial strife, it is a violation of the Federal Claims Act (FCA). Be Wary of Repeat Overbilling Issues 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...

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