The Business Purpose, Step-Transaction, and Substance-Over-Form Doctrines May Limit the Income-Shifting

question 129

True/False

The business purpose, step-transaction, and substance-over-form doctrines may limit the income-shifting strategy.

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Definitions:

Diagnosis Code

Diagnosis Code refers to a code assigned to a diagnosis based on a standardized system, such as the International Classification of Diseases (ICD), used for healthcare billing and statistics.

Upcoding

Reporting a higher-level code than is appropriate for the service that was rendered, resulting in higher reimbursement; when a facility coder assigns a diagnosis code that does not match patient documentation, with the intention of increasing reimbursement to the facility through the DRG system, serious penalties and fines will be levied against the facility for submitting fraudulent claims.

DRG System

Diagnosis-Related Group (DRG) system is a way of categorizing hospital cases into groups for the purposes of payment, reflecting typical resource usage for a stay.

External Causes Of Injuries

Factors outside the body that can cause physical harm, such as accidents, violence, or environmental exposure.