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Question: 1 / 400

What action should be taken if a coding audit reveals that a coding professional is intentionally coding for higher reimbursement?

Increase their training opportunities

Ignore the behavior

Counsel the coding professional and stop the practice immediately

When a coding audit indicates that a coding professional is intentionally coding for higher reimbursement, counseling the individual and stopping the practice immediately is essential for several reasons.

First, intentional miscoding can lead to severe consequences, including legal ramifications for both the individual and the organization. Healthcare coding professionals are held to strict ethical standards, and fraudulent coding practices violate regulations such as the False Claims Act. By addressing the behavior promptly, the organization upholds compliance with legal requirements and reinforces the importance of ethical medical coding.

Additionally, intervening immediately helps to maintain the integrity of the coding process. It prevents potential financial losses for the organization and safeguards against audits, fines, or penalties from regulatory bodies. Educating the coder on proper coding practices and the potential implications of their actions promotes accountability and helps reinforce the importance of accuracy in coding.

The other choices may not adequately address the severity of the issue. Increasing training opportunities doesn't directly confront the misconduct and could prolong the unethical behavior. Ignoring the behavior risks normalization of fraudulent coding within the organization, and notifying the insurance provider may not be appropriate until internal measures have been taken to understand and address the situation.

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Notify the insurance provider

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