tci Part B Insider - 2017 Issue 8

Physician Notes: Focus on Medical Necessity to Avoid Upcoding Issues, DOJ Case Suggests

Hint: Your documentation dictates your coding. Upcoding — year after year, it remains one of the HHS Office of Inspector General’s top targets. Due to unclear note taking and the occasional EHR error, it happens accidentally to almost everyone. But for the most part, the practice of choosing a higher-paying code is done willfully — and in a recent North Carolina case, a healthcare organization had to pay $6.5 million to rectify its upcoding situation. The Department of Justice’s (DOJ) qui tam case concerns a Charlotte-area organization, Carolina Healthcare System (CHS), which repeatedly billed urine drug...

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