“Defensive” Undercoding Is Indefensible


Undercoding, or reporting a lesser service than was performed and documented, is sometimes employed as a defensive strategy to stave off claims denials or audits. But, undercoding can make a provider an outlier, and may create consequential patient care, compliance, and financial liabilities. For example:

Undercoding Leaves Money On The Table, Driving Down Provider Reimbursement

As stated in “Over coding? Under coding? RIGHT coding!” by Novitas, a Medicare contractor in Delaware, Maryland, New Jersey, Pennsylvania, and Washington, D.C., “…under coding impacts your practice revenue. You are not being appropriately paid for the level of service you provide to your patients. Correcting under coded claims can mean costly appeals.”

Undercoding Leads To Improperly Paid Claims

Per Novitas, “When there is an underpayment due to under coding… it is counted as an improper payment error…. Under coding errors can statistically impact calculated error rates in the tens of millions of dollars[emphasis in the original].”

Undercoding Affects Patients Negatively, And Skews The Data That Medicare And Other Payers Use To Calculate Payments

Novitas states,“Under coding misrepresents the true level care that is provided to Medicare beneficiaries. These statistics are used to calculate future Medicare payments and track trends in healthcare delivery.”

Undercoding May Increase Your Risk of Audit

Novitas notes, “Patterns of under coding may be viewed as aberrant and open your practice up to audits and reviews.”

Finally, undercoding—just like overcoding—can create false claims liability. In short, Novitas concludes, “It’s important to code the level service that is supported by your documentation….”

For More Information:  https://www.aapc.com/blog/46046-defensive-undercoding-is-indefensible/