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  • Fraud and Abuse in Coding

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    Fraud and abuse in medical coding can take several forms such as upcoding, unbundling codes, or billing for services not rendered. The consequences of fraud and abuse are severe and can include investigations, exclusion from federal healthcare programs, fines, penalties, and even jail time. To avoid these consequences, medical coders should stay up to date on laws and policies, verify information is accurate, and report any suspicious activity.

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    fraud and abuse in coding

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    Fraud and abuse in medical coding can take several forms such as upcoding, unbundling codes, or billing for services not rendered. The consequences of fraud and abuse are severe and can include investigations, exclusion from federal healthcare programs, fines, penalties, and even jail time. To avoid these consequences, medical coders should stay up to date on laws and policies, verify information is accurate, and report any suspicious activity.

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    17 views4 pages

    Fraud and Abuse in Coding

    Uploaded by

    api-510033151
    Fraud and abuse in medical coding can take several forms such as upcoding, unbundling codes, or billing for services not rendered. The consequences of fraud and abuse are severe and can include investigations, exclusion from federal healthcare programs, fines, penalties, and even jail time. To avoid these consequences, medical coders should stay up to date on laws and policies, verify information is accurate, and report any suspicious activity.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    of 4

    TACKLING FRAUD AND ABUSE IN CODING

    What is FRAUD AND ABUSE


    What is fraud and abuse for coding
    ICD -10 and CPT
    Upcoding, unbundling ,reporting
    more codes than necessary
    Billing for items or services not
    rendered or not provided as claimed
    Submitting claims for equipment ,
    medical supplies, and services that
    This Photo by Unknown Author is licensed under CC BY-SA
    are not reasonable and necessary.
    CONSEQUENCES
     Investigations
     Exclusion from Federal Healthcare
    Programs
     Fines, Penalties
     Jail
    INSTEAD STAY UP TO DATE
     Laws, regulations , policies
     Verify information accurate in
    clinicals
     Look out and Report suspicious
    activity

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