What does upcoding involve in healthcare billing?

Upcoding in healthcare billing refers specifically to the practice of billing for a service at a higher level than what was actually provided. This method typically involves coding for more complex or extensive services than were actually administered, leading to increased reimbursement from insurers or patients. It is considered fraudulent behavior, as it misrepresents the level of care provided and can result in significant financial gain for the provider at the expense of payer integrity and ultimately patient costs.

This choice contrasts sharply with the other options. Billing for services not performed relates to outright fraud by charging for nonexistent services, while exchanging gifts to influence healthcare decisions pertains to unethical practices in provider-patient relationships rather than billing. Finally, billing each step of a procedure separately deals with charge capture practices and may not inherently imply any fraudulent intent, unlike upcoding which explicitly denotes misrepresentation of services rendered.