Medical Coding Practice Test 2025 - Free Medical Coding Practice Questions and Study Guide

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What does "upcoding" refer to in medical billing?

Increasing the cost of billing materials

Billing for a service that was not provided

Billing fraudulently for a higher service than performed

Upcoding refers specifically to the practice of billing for a service at a higher level than what was actually provided or performed. This type of fraudulent billing can occur when a healthcare provider deliberately uses a more expensive billing code to increase reimbursement from insurance companies or patients. This not only misrepresents the service delivered but can also lead to severe legal consequences for the provider, including fines and loss of licensure.

In contrast, increasing the cost of billing materials is unrelated to the coding process, while billing for a service that was not provided is characterized as "phantom billing," which is another form of fraud but distinct from upcoding. Adjusting billing codes to match insurance guidelines without misrepresenting the service provided is a legitimate practice and not considered upcoding.

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Adjusting billing codes to match insurance guidelines

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