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April 24, 2012

The most common coding abuses by a physician practice

I was watching a special on CNBC about healthcare fraud and it reminded me again about the most common coding abuses by physicians and their billing staff. Compliance in coding and documentation are crucial in today's enforcement enviroment. Don't get yourself in trouble by being ignorant or complacent:

Upcoding Billing using a more expensive code that the service or item that was actually provided.

Unbundling Billing separately for services that are properly grouped together in a global code.

Lack of Medical Necessity Billing items or services to patients that they do not need.

Billing for Services Not Rendered Billing something that was not actually provided to the patient.

Billing for Worthless Services Billing for items or services that are of such low quality as to render them virtually worthless.

Duplicate Billing Billing two or more times for the same item or service.

Lack of Documentation The medical record cannot support the claim.

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