What does submitting a claim for E/M with a different date of service indicate?

What does submitting a claim for E/M with a different date of service indicate?

• A. Compliance
• B. Fraud
• C. Improper billing
• D. Audit risk

Answer: (B)

Submitting a claim for Evaluation and Management (E/M) services with a different date of service signifies potential fraudulent behavior. This is because it could indicate an attempt to misrepresent the date when the services were rendered, which is a serious violation of billing and coding ethics. When claims are submitted with inaccurate dates, it raises a red flag for payers, potentially suggesting that the provider is trying to manipulate the timing of services to gain higher reimbursement rates or to bypass regulations that apply to specific service dates. Fraudulent claims can lead to severe repercussions, including penalties, fines, and even criminal charges, depending on the intent and the extent of the discrepancies. In contrast, other options like compliance or proper billing would indicate accurate and honest representation of services, while audit risk refers to the potential for claims to be subjected to review due to discrepancies or patterns that appear irregular—not specifically tied to the date of service misrepresentation.

Submitting a claim for Evaluation and Management (E/M) services with a different date of service signifies potential fraudulent behavior. This is because it could indicate an attempt to misrepresent the date when the services were rendered, which is a serious violation of billing and coding ethics.

When claims are submitted with inaccurate dates, it raises a red flag for payers, potentially suggesting that the provider is trying to manipulate the timing of services to gain higher reimbursement rates or to bypass regulations that apply to specific service dates. Fraudulent claims can lead to severe repercussions, including penalties, fines, and even criminal charges, depending on the intent and the extent of the discrepancies.

In contrast, other options like compliance or proper billing would indicate accurate and honest representation of services, while audit risk refers to the potential for claims to be subjected to review due to discrepancies or patterns that appear irregular—not specifically tied to the date of service misrepresentation.