Medical Auditing Practice Exam 2025 – 400 Free Practice Questions to Pass the Exam

Overcoding refers to the practice of assigning a coding level to a service or procedure that exceeds the actual service provided. This can lead to serious consequences, including allegations of potential fraud. When providers overcode, it suggests that they are attempting to receive reimbursement for more services than were actually performed, which can trigger audits, investigations, and even legal actions from payers and regulatory bodies. This is particularly important in healthcare settings where ethical standards and compliance with billing regulations are of utmost importance. Overcoding not only places a financial risk on providers due to the threat of penalties but can also damage their reputation and credibility.

In contrast, options that suggest decreased revenue or enhanced access to services do not logically follow from the action of overcoding. Decreased provider revenue typically results from undercoding or improper billing practices, while increased patient access to services contradicts the very nature of overcoding, which focuses on maximizing reimbursement rather than patient care. Enhanced accuracy in patient records is also unrelated, as overcoding actually compromises the integrity of medical documentation.