question archive The HIM Coding Manager has reviewed recent claims submitted and finds a demand letter of fraudulent overpayment of 200 claims, which had their laboratory charges unbundled when submitted for payment
The HIM Coding Manager has reviewed recent claims submitted and finds a demand letter of fraudulent overpayment of 200 claims, which had their laboratory charges unbundled when submitted for payment
Subject:Health SciencePrice: Bought3
The HIM Coding Manager has reviewed recent claims submitted and finds a demand letter of fraudulent overpayment of 200 claims, which had their laboratory charges unbundled when submitted for payment. As a result, the facility was overpaid by $85.00 on each claim. The HIM Director pleads their case and explains that this is a first-time offense and was caused by three new coders. OIG accepts their appeal but requires them to repay the overage and to prepare a corrective action audit plan for the Coding Compliance Plan and that it be submitted to OIG for review.
In a Word document, answer the following questions:
- How much will the facility have to repay for the overage?
- What would have been the unbundling penalty against the facility if OIG had enforced the penalty?
- Explain unbundling, calculate the repayment, and calculate what the additional penalty would have cost the facility.
- What type of corrective actions should be included in the Coding Compliance Plan that should correct this issue?
