By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    healthcare cybersecurity
    4 Helpful Tips on How to Protect Your Medical Practice Against Cyber Attacks
    October 24, 2021
    Health Check Diagnosis Medical Condition Analysis Concept
    6 Health Woes With Online Remedies
    January 19, 2022
    Eight Things Men Should Know About the Male Menopause
    Eight Things Men Should Know About the Male Menopause
    April 24, 2022
    Latest News
    Beyond Nutrition: Everyday Foods That Support Whole-Body Health
    June 15, 2025
    The Wide-Ranging Benefits of Magnesium Supplements
    June 11, 2025
    The Best Home Remedies for Migraines
    June 5, 2025
    The Hidden Impact Of Stress On Your Body’s Alignment And Balance
    May 22, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Does Insurance Cover the Cost of Therapy?
    June 14, 2022
    mental health loss loved one
    Covering Your Own Medical Issues After Losing a Loved One
    July 21, 2024
    healthcare SaaS
    Venture Capital Trends for Healthcare SaaS Platforms
    May 24, 2024
    Latest News
    Cigarette Makers Sue the FDA Over New Labeling Rules
    July 8, 2025
    End-Use Verification: Simple but Potentially Powerful
    July 8, 2025
    How Much do Financial Incentives Matter to Physicians?
    July 8, 2025
    NanoViricides Reports Positive Anti-viral Effect of HIV Drug
    July 8, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Upcoding
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Policy & Law > Upcoding
Policy & Law

Upcoding

JasonShafrin
JasonShafrin
Share
2 Min Read
SHARE

Would Congressman Ryan’s proposal solve this problem?

Would Congressman Ryan’s proposal solve this problem?

Medicare Part B pays outpatient physicians according to the billed Current Procedural Terminology (CPT) codes, which differ in procedure and intensity….Using nationally representative data from the 2001 to 2003 Medicare Current Beneficiary Survey, this paper…finds strong evidence that these fee differentials influence physician’s coding choice for billing purposes across a variety of specialties. For general office visits, Medicare outlays attributable to upcoding may sum to as much as 15% of total expenditures for such visits.

Likely no. For physicians paid by private insurers, they would still have an incentive to upcode. It is possible that private insurers may be better at policing upcoding, but their extra vigilience may also cause physicians to hesitate from providing necessary services since they fear they’ll be targeted for upcoding. On the other hand, for integrated managed care organizations like Kaiser Permanente, they have the opposite incentive. These providers are rewarded for reducing cost and thus insurers may claim to have providers services they did not in fact perform.

Although privatizing Medicare and/or Medicaid could solve some problems, upcoding is not likely to be one of them.

More Read

New Insurance Rate Reporting Tool Goes Live Online
How Telehealth and 5G are Transforming Healthcare?
Time to Buy That Pet
Person-Centered HealthCare: Using Infographics to Educate Audiences About the Flu
DC Conference: FDA At A Crossroads
  • Brunt, C. S. (2011), CPT fee differentials and visit upcoding under Medicare Part B. Health Economics, 20: 831–841. doi: 10.1002/hec.1649.
TAGGED:health care policyinsurance
Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

Health Care Buzz Today
Business
July 8, 2025
As We Mature (age), Things Change…
Orthopaedics
July 8, 2025
FDA Approves Roche (Genentech) Skin Cancer Drug–Zelboraf
Business
July 8, 2025
Smart Money on Pfizer?
Business
July 8, 2025

You Might also Like

Do We Have It All Wrong About Obesity?

March 1, 2011
How to engage your patients on social media – without violating HIPAA!
Policy & LawSocial Media

How to engage your patients on social media – without violating HIPAA!

August 17, 2016
Public Health

How To Get Rid Of Belly Fat: The Roles Diet, Stress, And Exercise Play In Belly Fat Reduction (Part 2)

June 4, 2012
ACOs expanding
BusinessFinanceHealth ReformPolicy & LawPublic Health

ACOs Rapidly Expanding Across States

May 2, 2014
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?