What are the risks associated with improper code selection?

Improve your CPT HCPCS Level I Coding Test readiness. Utilize our resources featuring flashcards and multiple-choice questions, with hints and detailed explanations. Fully prepare for your assessment today!

The identified answer emphasizes the potential financial and legal repercussions that can arise from selecting the wrong codes for medical billing and coding. When codes are improperly selected, it can lead to claim denials where insurance payers refuse to process the claims due to inaccuracies, resulting in delays in payment. Additionally, improper coding can result in overbilling, where a provider charges for more services than were actually rendered, or underbilling, where services provided are not accurately reflected, leading to lost revenue.

These issues can escalate to involve audits by insurance companies, which may further scrutinize the coding accuracy. In severe cases, persistent inaccuracies can attract legal action or regulatory scrutiny, resulting in penalties or fines for fraudulent coding practices. Thus, the financial implications of incorrect code selection are significant, impacting not just the practice's income but also its reputation and compliance with healthcare regulations.

The other answer choices do not accurately capture the direct and detrimental effects of improper coding. Increased patient satisfaction rates, higher reimbursement rates, and enhanced compliance with healthcare regulations generally result from accurate coding practices rather than from the consequences of improper code selection.

Subscribe

Get the latest from Examzify

You can unsubscribe at any time. Read our privacy policy