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False claims include claims when the service:

a. is not rendered
b. is already covered under another claim
c. is miscoded
d. is supported by the documentation in the patient's medical record

User Simha
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1 Answer

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Final answer:

False claims in healthcare relate to inaccurately represented medical services to insurers, including unrendered services, duplicate coverage, miscoding, and unsupported documentation.

Step-by-step explanation:

A false claim in healthcare refers to a claim for a medical service or procedure that is inaccurately represented to an insurance company or payer. False claims can include a variety of situations; they can be submitted when a service is not rendered, meaning no actual service was provided to the patient.

If a service is already covered under another claim, it should not be billed again, as this would be considered fraudulent. Coding is an essential part of the billing process, and a claim is miscoded when the codes do not accurately reflect the services provided. Finally, all claims must be supported by the documentation in the patient's medical record; without this, a claim could falsely represent the services provided.

User Miro
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