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Code gaming????

kparkhurst

Networker
Messages
67
Location
Lancaster, NY
Best answers
0
I am revamping our billing company's compliance plan and while reading the OIG guidance for third-party billing companies I came across the phrase "code gaming" (Found in #1 of the 7 elements). Can anyone tell me what this is? I have not heard of this term before.:confused:
 

mitchellde

True Blue
Messages
13,538
Location
Columbia, MO
Best answers
2
From an article I downloaded from the OIG recently.....
Billing practices such as “fragmentation,” “exploding charges,” “upcoding,” “code creep” and, even multiple coding are examples of physician “gaming.” Examples of “gaming” include billing for 17 different lab tests run as part of a single blood screening. Billing for items separately brings a higher reimbursement. Expert estimates of the financial loss due to “gaming” range from negligible to 15 percent of total physician claims.
 
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