Question

If an office has a pattern of downcoding, what is the effect on insurance payments?

a) Increased payments
b) Decreased payments
c) No effect on payments
d) Faster reimbursement

Answer 1

When an office has a pattern of downcoding, it can result in decreased insurance payments for the office.

Step-by-step explanation:

When an office has a pattern of downcoding, it means that they change the billing codes for medical procedures to lower-cost codes. This can have a significant effect on insurance payments because the insurance company will reimburse the office based on the lower-cost codes, resulting in decreased payments for the office.

For example, if a procedure is originally coded as a more expensive service, but the office downcodes it to a less expensive service, the insurance company will only reimburse the office at the lower rate.