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AUGUST 21st
By Dr. David Edward Marcinko MBA CMP
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It’s National Report Upcoding Fraud Day, an initiative started in 2017 to support whistleblowers of Medicare fraud, which costs the US billions of dollars each year. If you need any encouragement to report suspected healthcare fraud (like upcoding or inflated Medicare reimbursement claims), here’s your chance.
CITE: https://www.r2library.com/Resource
What Is Upcoding?
Upcoding is defined as having a doctor or billing person assign an inaccurate billing code to a medical procedure or treatment. It’s done to increase the reimbursement to that physician.
Beyond that, CPT codes are 5-digit codes that tell billing and insurance companies what was done to you while in that physician’s care. It may sound straightforward, but with around 7,800 codes in use, it isn’t hard to get things mixed up or to miss the fact that they overcharged you for a service.
Sometimes the mistake is made in error. In other situations, the office or hospital may mix it up intentionally. Most often, intentional miscoding happens when the facility is billing Medicaid or Medicare. Again, this may not seem like a big deal for you since the government covers it, but it may still affect your ability to get the healthcare that you need.
MORE: https://medicalexecutivepost.com/2022/11/05/medical-billing-down-and-up-coding/
And so, National Report Upcoding Fraud Day is on August 21st. An initiative by Joel Hesch, a former attorney with the Department of Justice. Hesch and a passionate advocate for whistleblowers, created the day for anyone looking to report healthcare fraud. He wanted to make it easier, so everyone could get the process right. The day generates awareness and detailed steps on how the general public can report unethical healthcare providers. Fraudsters siphon off $65 billion each year in Medicare fraud through inflated reimbursement claims. Upcoding is one of the most rampant types of healthcare fraud that must end.Hesch draws on his 15 years as an attorney in the D.O.J. to support and encourage whistleblowers to come forward. The most successful claims have two things in common – facts and the use of proper reporting channels. National Report Upcoding Fraud Day aims to empower anyone with a legitimate case for claims.
RELATED: https://medicalexecutivepost.com/2013/06/05/understanding-the-spoils-of-healthcare-fraud-and-abuse/
COMMENTS APPRECIATED
Thank You
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Filed under: "Doctors Only", Accounting, Career Development, Ethics, Experts Invited, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Information Technology, Professional Liability, Quality Initiatives, Taxation, Touring with Marcinko | Tagged: david marcinko, Joel Hesch, MGN, national fraud upcode day, National Report Up-Coding Fraud Day, national upcoding report day, upcode, upcoding | Leave a comment »
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