HealthIT Answers June 30, 2023
By Ritesh Ramesh, CEO, MDaudit
Twitter: @MDaudit
Overcoding may net higher reimbursements for healthcare organizations, however the ramifications of getting caught far outweigh the revenue boost – and the likelihood of that happening are high as Centers for Medicare and Medicaid Services (CMS) continues its quest to ferret out fraud and abuse and recoup improper reimbursements. This year alone, the USC Schaeffer Center for Health Policy and Economics predicts those improper reimbursements will include overpayments to Medicare Advantage (MA) plans of $75 billion, a figure that is likely to rise as millions of beneficiaries move from traditional fee-for-service Medicare to MA.
Whether intentional or accidental, overcoding can result in significant fines in addition to repayment of the original claim. Not to...
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