Upcoding Can Cost You Money
Upcoding is
fraudulent medical billing that costs us all money, and possibly our health.
Here's how upcoding works, why it is so costly to patients, and what we can do
to help stop it.
Each procedure
performed by a doctor or other healthcare provider has a code attached to it
that allows them to bill your insurance, Medicaid or Medicare, or whoever your
payer is (even you.) That code is called a CPT code (current procedural
terminology).
When your
doctor sends in his or her bill to your payer, that CPT code determines how
much he or she will get paid. Of course, different codes allow them to bill for
higher or lower amounts of money.
As long as the
provider uses the right code, then the provider will be paid whatever he or she
has earned by performing the services and procedures performed.
Upcoding,
then, refers to the practice of assigning a code that commands more money than
the correct code would pay. For example, say the doctor sees you for a quick
check up. The code for that might mean she would get paid $50. But she might
assign it the CPT code for an expanded check-up, which means she would be paid
$100.
The final
result of Upcoding is an AUDIT.
HPP Management Group, Corp. the titled-holder of Health Plans
Path, Corp (HPP) and also the developers of the AccuChecker Product Line is a
group of healthcare consultants servicing physicians and payers since 1983.
The HPP
consultants have contributed to healthcare providers in many ways:
The
Management Group has represented physicians in over 500 Medicare and Medicaid
audits of overpayment assessments and has recovered millions of dollars for our
clients. The knowledge acquired in the audits served as the basis to develop
the AccuChecker Product Line.
For more
details, please call : 305-227-2383
or 1-877-938-9311
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