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Coding & Reimbursement

Use of Dental Related ICD Coding to Determine Comorbidities in Mississippi

By Priscilla Nordan, MHIIM; Shamsi Daneshvari Berry, PhD, MS, CPHI; and Mary E. Morton, PhD, RHIA

Over the years, there has been a substantial effort to improve patient health and reduce healthcare costs through preventive medicine. Regular dental care prevents tooth decay; published research shows how oral health can impact other organs, such as the heart. Heart disease is the leading cause...
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Upcoding Medicare: Is Healthcare Fraud and Abuse Increasing

By Alberto Coustasse, DrPH, MD, MBA, MPH; Whitney Layton, MS; Laykin Nelson, MS; and Victoria Walker, MS

Medicare fraud has been the cause of up to $60 billion in overpaid claims in 2015 alone. Upcoding occurs when a healthcare provider has submitted codes for more severe conditions than diagnosed for the patient to receive higher reimbursement. The purpose of this study was to assess the...
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