Fraud, Waste, And Abuse (FWA) 2 Practice Exam

Which practice involves billing for higher service or item codes than those actually performed?

Fraud Kickback Unbundling Upcoding

Correct Answer:

Upcoding

Explanation:

Upcoding is billing for a higher-cost code than the service actually performed. In medical coding, each service has a code that reflects its complexity, time, and resources used. When a provider uses a more expensive code than what was delivered, the payer pays more than warranted. This intentional misrepresentation is a form of fraudulent billing and can lead to audits, repayment of funds, and penalties. For context, unbundling would involve billing separate components that should be covered by a single code, which is a different improper practice; kickbacks relate to improper payments for referrals, not the coding itself. So the described practice is upcoding.

Access more questions from this quiz

Continue to Fraud, Waste, and Abuse (FWA) 2 Practice Exam for more practice questions and the full quiz experience.

Access More Questions