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Fraud and Abuse in Coding

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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92 views4 pages

Fraud and Abuse in Coding

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.

Uploaded by

api-510033151
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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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
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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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