Medical Auditing Practice Exam 2025 – The Comprehensive All-In-One Guide to Exam Success!

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What is the practice of coding for a higher-level service than what was actually performed called?

Upcoding

The practice of coding for a higher-level service than what was actually performed is known as upcoding. This unethical practice involves misrepresenting the services provided by assigning a code that reflects a more complex or more time-consuming service than what was actually delivered. Upcoding can lead to higher reimbursements from insurance companies or government programs, which is why it is deemed fraudulent and is heavily scrutinized in medical auditing.

Upcoding not only violates the principles of medical coding but also poses risks to healthcare providers, as it can lead to audits, fines, and potential legal consequences. Understanding this concept is critical for medical coders and auditors, who must ensure accuracy and compliance in coding practices to maintain the integrity of healthcare billing systems.

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Underbilling

Overcoding

Cross-coding

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