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Wiki Internal Audit - upcoding etc.

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maine4me

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When a service has been upcoded and was applied to the patient's deductible, how do you handle this? Do you just leave everything as is? I guess they patient would have to pay the deductible either way, but it does not seem right to keep the money. I would appreciate any one's advise.
 
It would depend on the seriousness of the upcode. If it was off by one level, I would leave it alone. If it was off by more than that, I would resubmit to the insurance carrier which would bring the allowed amount down and hence the patient overpaid and would be necessary for a refund to the patient.
 
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