What Is Upcoding?
Billing for a higher-level service or procedure code than what was actually provided to the patient. This is a form of fraud that results in inappropriate reimbursement and can lead to legal penalties and license revocation.
Upcoding across 2 exams
Upcoding appears on the following exams. Each defines it in the context candidates are tested on:
- CBCS (NHA)
- Billing for a higher-level service or procedure code than what was actually provided to the patient. This is a form of fraud that results in inappropriate reimbursement and can lead to legal penalties and license revocation.
- CPC
- The fraudulent practice of billing for a more expensive service or higher level of care than what was actually provided or documented.