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Under coding

  1. Default Administrator
    Medical Coding Books
    Under coding and over coding is fraud. How about recoding? How many times can you recode a claim? Some doctors call this practice recoding and they recode (under code) the claims if Medicare denied or if the claim was never worked and is past the timely filling. The doctor then recode the claim and submit the claim as a brand new claim. Is this Legal? It is my opinion that is the same as under coding or over coding and is fraud. What is your opinion? Maria

  2. #12
    Charleston, WV
    My opinion is that knowingly submitting a claim that is coded incorrectly is fraud. "Coding to get paid" is always wrong (with the exception of those payers who give you specific instructions). I thinks it's okay to recode if the claim was coded incorrectly the first time. I also think it's okay to recode as many times as it takes until it's coded correctly. However, if you do this routinely, i would expect auditors to come knocking. At the very least I would expect one of those infamous "re-education" letters from my Medicare carrier. i'm not sure how recoding and billing as a new claim would ever get you past timely-filing requirements but if a claim has been recoded, I think you should follow the payer's corrected claim guidelines.

  3. Default undercoding
    Let me correct my statement that undercoding and overcoding is fraud. It is only fraud if done on purpose. You can undercode or overcode in error and that is not fraud. you can correct the claim and re-file. I never heard of a physician penalized for undercoding only for overcoding. If the documentation sopports the level of care, you can submit a corrected claim as long is supported by documentation. The False Claims Act imposes liability on any person who submits a claim to the federal government that he or whe knows (or shold know) is false. You can make your own definition of false claim.

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