Federal Panel Finds No Evidence of Upcoding

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A panel investigating allegations of rampant “upcoding” by healthcare providers came away empty during a brief hearing on the issue.

“We don’t have any data, positive or negative, that would be useful,” said Paul Tang, chair of the panel named by Health Information Technology at the U.S. Department of Health and Human Services.

Upcoding has been a crusade by the Center for Public Integrity, which has published numerous articles on the subject. The Center found that healthcare providers have increasingly submitting claims to Medicare under the 99124 and 99125 evaluation/management codes, which provide the highest rates of reimbursement. Although it has found to date zero evidence of upcoding, the Center has speculated that providers have over-billed Medicare by as much as $11 billion.

Farzad Mostashari, National Coordinator for Health IT appointed the panel of experts last year in the wake of the Center’s slough of stories. The panel convened recently and heard from four witnesses, but came away with no conclusions, according to a Center report.

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Posted in Denials Management, Medical Receivables, Patient Experience, Patient Financial Services .

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