What are coding practices that are inconsistent with accepted norms referred to as?

Coding practices that are inconsistent with accepted norms are referred to as abuse because they generally involve improper billing practices that do not meet the legal or ethical standards set by industry regulations. This can include practices such as upcoding, where a provider bills for a more expensive service than what was actually provided, or unbundling, which refers to billing separately for services that are typically billed together.

What distinguishes abuse from fraud is that abuse entails practices that are generally considered improper but may not be intentional. While abuse can lead to unnecessary costs to the healthcare system and may result in penalties, it does not have the same intentional deceitful connotation typically associated with fraud, which implies a deliberate intention to deceive for personal gain.

Negligence refers to a failure to take proper care in doing something, while misrepresentation involves providing false information, which might not necessarily relate directly to the standards of coding practices. In contrast, abuse is specifically tied to coding practices and billing procedures in the healthcare context.