Reply to Are you "allowed" multiple issue at your doctors appointments?

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[quote=Anonymous][quote=Anonymous][quote=Anonymous]I would like to know if the providers on this thread talking about "insurance fraud" were born yesterday, or think that we were. Insurance fraud is billing insurers for services that aren't provided, or billing for more intensive services than were provided, or providing and billing for services that aren't necessary. There is no fraud involved with providing additional services during one visit. In fact, insurers almost always prohibit a provider from billing for 2 visits for the same patient in the same day. If the services can reasonably be provided in one visit, the insurer WANTS the provider to do that. And of course that's the case, because requiring the patient to come back another day costs the insurer more money.

No, this penny-ante BS is about providers generating revenues by billing as much as they possibly can. It costs insurers more, but ultimately it costs patients more, in increased premiums and copays. And it's terrible medical care. A good clinician should not be making it as difficult and inconvenient as possible for patients to get the care they need.

That said, PPs are correct that "wellness" visits are not designed for patients' needs. They're mostly an opportunity for providers to collect medical information, which insurers then use to justify raising premiums. At wellness visits, the goal is to hear about and record everything that's wrong with you, not to do anything about it. So if you want an annual check-up, make sure you are making an appointment for one, and not for a "wellness" visit.[/quote]

1. Under coding is absolutely considered insurance fraud, just like overriding 
2. There is no billing difference between an annual check up, a wellness visit, or a preventative care visit. They are all the exact same thing from a billing perspective. It doesn’t matter what you call it. [/quote]

Avoidance of undercoding is a deliberate billing strategy. It is a letter of law reading of billing rules that deliberately skirts intent. This provides a great example of the phenomenon.

https://www.aapc.com/blog/26957-undercoding-is-no-better-than-overcoding/

"Nothing in the [Medicare fraud] document specifically talks about “down coding” or “under coding,” but if you read between the lines, you’ll recognize under coding as a compliance risk."

Actually, the document doesn't talk about it because Medicare doesn't consider it to be fraud.[/quote]

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