Upcoding
Also called: Overcoding
In plain English
A billing practice (which can be fraud) where a provider bills for a more expensive service than what was actually performed. This results in higher charges to you and your insurance.
Real-world example
You have a routine 15-minute follow-up visit (should be CPT 99213, ~$92 Medicare rate) but get billed as a complex visit (CPT 99215, ~$175 Medicare rate). The difference might cost you an extra $100+ in coinsurance.
Why this matters for your bill
Upcoding is one of the most common medical billing errors/abuses. It's hard to catch unless you know what the codes mean. The biggest red flag: your ER visit being coded at Level 5 (99285) when you walked in with something minor.
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