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Questions and Answers
What is the term for submitting separate claims to insurance provider for services that could fit on a single bill?
What is the term for submitting separate claims to insurance provider for services that could fit on a single bill?
- Up coding
- Unbundling (correct)
- Under coding
- Falsifying medical records
What is the term for falsely assigning a higher billing code to a service?
What is the term for falsely assigning a higher billing code to a service?
- Misrepresenting medical records
- Up coding (correct)
- Under coding
- Separate coding
What is the term for deliberately assigning a lower billing code to a service to reduce reimbursement?
What is the term for deliberately assigning a lower billing code to a service to reduce reimbursement?
- Up coding
- Under coding (correct)
- Down coding
- Misrepresenting medical necessity
What is the term for intentionally breaking a procedure or service into its component parts to maximize reimbursement?
What is the term for intentionally breaking a procedure or service into its component parts to maximize reimbursement?
What term describes the fraudulent act of altering medical records to support incorrect billing?
What term describes the fraudulent act of altering medical records to support incorrect billing?
What is the term for submitting separate claims to insurance provider for services that could fit on a single bill?
What is the term for submitting separate claims to insurance provider for services that could fit on a single bill?
What is the term for deliberately assigning a lower billing code to a service to reduce reimbursement?
What is the term for deliberately assigning a lower billing code to a service to reduce reimbursement?
What is the term for falsely assigning a higher billing code to a service?
What is the term for falsely assigning a higher billing code to a service?
What term describes the fraudulent act of altering medical records to support incorrect billing?
What term describes the fraudulent act of altering medical records to support incorrect billing?
What is the term for intentionally breaking a procedure or service into its component parts to maximize reimbursement?
What is the term for intentionally breaking a procedure or service into its component parts to maximize reimbursement?
Flashcards
Unbundling
Unbundling
Submitting multiple claims for services that could be on one bill.
Upcoding
Upcoding
Assigning a higher billing code than warranted for a service.
Under coding
Under coding
Assigning a lower billing code than warranted for a service.
Unbundling
Unbundling
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Falsifying medical records
Falsifying medical records
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Unbundling
Unbundling
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Under coding
Under coding
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Upcoding
Upcoding
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Falsifying medical records
Falsifying medical records
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Unbundling
Unbundling
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Study Notes
Insurance Fraudulent Practices
- Unbundling: submitting separate claims to insurance provider for services that could fit on a single bill.
- Upcoding: falsely assigning a higher billing code to a service.
- Downcoding: deliberately assigning a lower billing code to a service to reduce reimbursement.
- Fragmentation: intentionally breaking a procedure or service into its component parts to maximize reimbursement.
- Falsification of records: fraudulent act of altering medical records to support incorrect billing.
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