Reimbursement procedures are complex and detailed, especially those associated with government programs such as Medicare. Part of the regulatory requirements of Medicare is to prevent illegal billing practices such as churning, upcoding, and unbundling. 

To read information on the federal regulations for reimbursement procedures, search the Internet using the following keywords: OIG supplemental compliance program guidance for hospitals. Also, search the Internet to locate similar information on your state regulations for reimbursement procedures. 

Compare and contrast the federal and state definitions based on the following pointers:

• Which issues regarding churning, upcoding, and unbundling are considered important?
• What are some of the specific examples of actions taken against providers engaged in these practices?
• Which regulation is the most restrictive and why?

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