What type of billing fraud occurs from always billing the same code for similar patient visits?

Assumption billing refers to the practice of consistently using the same billing code for similar patient visits without considering the specific details or complexities of each case. This is considered fraudulent because it assumes that all visits require the same level of service, which may not be accurate. This practice can lead to overbilling for services, as it does not reflect the actual care provided to each patient.

In professional compliance, it is crucial to bill accurately based on the individual patient’s needs and the specific services rendered. Using a uniform code for all patient visits misrepresents the nature of the services provided and can lead to significant legal and financial repercussions, as it breaches ethical guidelines and regulations surrounding healthcare billing.

Understanding the implications of assumption billing highlights the importance of thorough documentation and coding practices to ensure compliance with legal standards and maintain integrity in billing processes.