Bha-Fpx4006 Assessment 2.1 Identifying And Addressing Upcoding

This study source was downloaded by 100000867488176 from CourseHero.com on 07-25-2023 14:42:05 GMT -05:00https://www.coursehero.com/file/205428760/BHA-FPX4006-AndrzejewskiDalyn-Assessment-21docx/ Identifying and Addressing UpcodingDalyn AndrzejewskiBHA-FPX4006: Healthcare Regulation and Compliance Dr. WigginsMay 20231This study source was downloaded by 100000867488176 from CourseHero.com on 07-25-2023 14:42:05 GMT -05:00https://www.coursehero.com/file/205428760/BHA-FPX4006-AndrzejewskiDalyn-Assessment-21docx/Remove or Replace: Header Is Not Doc TitleIdentifying and Addressing Upcoding TemplateMajor Categories of Health Care Fraud and AbuseCategory of Health Care Fraud andAbuse Description of Category and Example from Authoritative Source*Billing for unnecessary services Performing and billing for services that are not medically necessary to increase a providers billing and reimbursement (CMS, 2021). An example would be performing a surgery when other non-invasive measures may have been as effective.Upcoding/Improper coding Incorrect billing which may include upcoding or not bundling certain codes. Using a higher Evaluation and Management (E/M) code than actually performed is upcoding. Unbundling would be billing two separate codes when one code would account for both of the other codes (CMS, 2021).Kickback A kickback would be receiving a gifts r rewards for patient referrals or any increase of business that would result in higher reimbursement (CMS, 2021). An example would be sending all surgeries to a specific doctor in exchange for use of that doctors vacation home.Duplicate claims When