What does "upcoding" refer to in revenue integrity?

Upcoding refers to the practice of coding a service at a higher level than what is justified by the service actually provided. This action can lead to increased reimbursement from payers but is considered unethical and potentially fraudulent. In the context of revenue integrity, it undermines the accuracy of billing practices, which can lead to legal repercussions and loss of trust with payers and patients.

The other options involve aspects of responsible billing practices and documentation. Coding services at a justified level reflects adherence to accurate billing guidelines, while accurate service documentation is essential for substantiating claims and ensuring that providers are reimbursed for legitimate services rendered. Reducing billing errors is a broader goal in revenue cycle management that contributes to overall financial health and compliance. However, none of these options capture the essence of upcoding, which specifically entails an unjustified elevation in service codes for financial gain.