Clinical Medical Assistant Certification Exam Practice Question
The assignment of a higher level of Evaluation and Management service when a lesser service Is rendered In an attempt to Increase reimbursement Is known as which of the following?
Correct Answer: D
Rationale: Upcoding refers to the practice of assigning a higher level of Evaluation and Management (E/M) service than what was actually provided, primarily to increase reimbursement rates. This practice is unethical and can lead to severe penalties.
Option A, bundling codes, involves grouping multiple services into a single code for billing, which is different from misrepresenting service levels. Option B, coordinating, typically refers to managing patient care and does not relate to billing practices. Option C, filing a dirty claim, denotes submitting incorrect claims but does not specifically indicate the intentional misrepresentation of service levels. Option E, using modifiers, refers to adding specific codes to clarify billing but does not imply upcoding.
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