Evidence-Based Recommendations to Address Upcoding

It is recommended that the best option and the only way to identify an Upcoding impasse is to collect and compare data on the E/M coding and billing. It is best to begin by aggregating all of the data for a given period, for instance, starting with data for the past few months from the system into a report, provider by provider.

(Bastani et al., 2019)

In detecting Upcoding or down coding, an individual must be conversant with the billing or fee schedule and be able to compare those to the amount mentioned on the E/M or the E.O.B. forms. In addition, the person must be familiar with the NCCI edits and mutually exclusive elements.

(Cook & Averett, 2020).

It is an issue of individual integrity; thus, individuals must make it a personal duty to ensure patient information is correct and aligned adequately with data and avoid Upcoding.

(Mackey et al ., 2020)

It is also recommended to utilize the current Medical coding manual to avoid billing duplication. In addition, there is a need to verify insurance benefits and coverage in Advance.

(Teng et al., 2020)

 If an individual is not knowledgeable about how health billing is done, it is recommended that the entity or individual hire a professional medical biller. We also recommend Improvement medical billing and coding systems with Coronis Health.

(Sonawala, 2019).