What is the practice of using a billing code that results in a higher reimbursement than the actual service rendered called?

The practice of using a billing code that results in a higher reimbursement than the actual service rendered is known as upcoding. This occurs when healthcare providers select a code that reflects a more expensive service than what was actually provided to the patient, leading to a greater reimbursement from insurance companies or government payers.

Upcoding is considered a form of fraud because it misrepresents the services performed in order to gain financial benefits. This act can have serious legal consequences for healthcare providers and can also lead to increased scrutiny from regulatory bodies, as it undermines the integrity of billing processes and can contribute to rising healthcare costs.

Understanding upcoding and its implications is crucial for ensuring compliance with legal and ethical billing practices in healthcare. It highlights the importance of accurate documentation and coding to reflect the true nature of services provided to patients.