There simply weren’t enough hours in the day to justify the fees Dr. Angel S. Martin collected from Medicare. On fifty-three separate days, the Newton, Iowa, general surgeon billed the government ...

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We collaborate with the world's leading lawyers to deliver news tailored for you. Sign Up for any (or all) of our 25+ Newsletters. Some states have laws and ethical rules regarding solicitation and ...

We’ve been accused of upcoding our therapy reimbursement claims. What can we do? “Upcoding” — billing for services under procedure codes that are reimbursed at higher rates than those applying to ...

Andrew S. Oseran, MD, MBA, MSc, hypothesizes that higher Medicare Advantage (MA) risk scores may result from either a more accurate capture of beneficiaries' comorbidities or inappropriate "upcoding" ...

ANAHEIM, CA—Most interventional cardiologists believe that public reporting of PCI outcomes leads to avoidance of procedures and upcoding of patient clinical comorbidities, according to a survey of ...

The Alliance for Quality Nursing Home Care and American Health Care Association expressed outrage over a news report that alleged widespread use of so-called “upcoding” in nursing homes. “This article ...

High-intensity billing during "treat and release" emergency department stays rose significantly from 2006 to 2019, and was partially fueled by factors such as changes in case mix and service offering ...

Medicare Advantage plans may have received higher payments as a result of upcoding from 2010 to 2014, according to new research published by Health Management, Policy & Innovation. The study's authors ...

In five states over nearly a decade, hospitals have increased how frequently they document patients as needing the highest intensity care, which has led to hospitals receiving billions in extra ...