Page 3 - Coder's Choice Magazine - Aug 2020
P. 3

August 2020  UPCODING:




                                      "AN OLD THIEF WITH A
                     RUMOR HAS IT!

                                                         NEW WAY"







                                                          hile being on lock-down for the hundredth  time,  I stum bled  on
                                                          an   article   with   the   most   intriguing   headl ine .   It   read   “Are
                                                          Hospitals   Gouging   Medicare   to   Treat   COVID-19   pa tient ?”
                                                          Now   this   article   came   about   as   a   resul t   of   the    American
                                                          Government    passing   the   CARES   ACT.   The    CARES   ACT
                                                          allows   hospitals   to   charge   Medicare,   an   American   nationa l
                                                          health   insurance   program   20%   more   to   treat   COVID-19
                                                          patients.

                              S h o r t l y    a f t e r ,    a    g e n t l e m a n    r e l e a s e d    a    F a c e b o o k    v i d e o    s t a t i n g    t h a t    h e    w a s    a d m i t t e d
                              i n t o    a    l o c a l    h o s p i t a l    a f t e r    h e    w a s    e x p e r i e n c i n g    s e v e r e    b a c k    p a i n s .    W h i l e    h e    w a s    i n
                              t h e   h o s p i t a l   h e   r e c e i v e d   a   C O V I D - 1 9   t e s t   w h i c h   c a m e   b a c k   n e g a t i v e .   O n c e   h e   w a s

                              d i s c h a r g e   a f t e r   a   f e w   d a y s   i n   a   b e t t e r   c o n d i t i o n   h e   g o t   a   t h r e e   t h o u s a n d   d o l l a r
                              b i l l ,    h o w ?    T h i s    g e n t l e m a n    w a s n ’ t    t h e    o n l y    p e r s o n    t h a t    s h a r e d    t h e i r    p e r s o n a l
                              e x p e r i e n c e   o n   s o c i a l   m e d i a   s i n c e   t h e   b i l l   w a s   p a s s e d .
                                     T h i s   e x c e s s i v e   c h a r g i n g   t o   p a t i e n t s   c a n   b e   d e s c r i b e d   a s   “ U p c o d i n g ” .   U p c o d i n g   i s
                              a    t y p e    o f    f r a u d u l e n t    a c t i v i t y    w h e r e    h e a l t h c a r e    p r o v i d e r s    s u b m i t    i n a c c u r a t e    m e d i c a l
                              b i l l i n g   c o d e s   t o   i n s u r a n c e   c o m p a n i e s   i n   o r d e r   t o   r e c e i v e   o u t r a g e o u s   r e i m b u r s e m e n t .

                              T h e s e    f a l s e    s u b m i s s i o n s    w o u l d    i n d i c a t e    t h a t    d o c t o r s    p r o v i d e d    p a t i e n t s    w i t h
                              t r e a t m e n t s    t h a t    a r e    c o m p l e x ,    c o s t l y ,    a n d    t i m e    c o n s u m i n g    t h a n    w h a t    t h e    p a t i e n t
                              a c t u a l l y    r e c e i v e d .    T h i s    c a n    c o s t    p a t i e n t s ,    h e a l t h c a r e    p r o v i d e r s ,    a n d    i n s u r a n c e
                              c o m p a n i e s   t h o u s a n d s   o f   d o l l a r s .
                              U p c o d i n g    h a s    b e e n    g o i n g    o n    f o r    m a n y    y e a r s    a n d    t h e    p a y o u t    c a n    b e    a s    h i g h    a s    a

                              b i l l i o n    d o l l a r s .    N o w    t h i s    l e a v e s    m e    t o    a s k    s o m e    i m p e r a t i v e    q u e s t i o n s .    I s    u p c o d i n g
                              h a p p e n i n g    i n    t h e    B a h a m a s ?    A n d    i f    i t    i s ,    h o w    l o n g    h a s    i t    b e e n    g o i n g    o n ?    A s    a
                              p a t i e n t   a n d   a   h e a l t h c a r e   p r o v i d e r   i t   i s   i m p o r t a n t   t h a t   y o u   b e   v i g i l a n t   t o   a v o i d   b e i n g
                              r o b b e d   b y   t h e s e   i n d i v i d u a l s .
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