Graduation Year


Document Type




Degree Granting Department

Business Administration

Major Professor

Sunil Mithas, Ph.D.

Co-Major Professor

Richard Tarpey, D.B.A.

Committee Member

Dahlia Robinson, Ph.D.

Committee Member

Christos Pantzalis, Ph.D.


billing fraud, coding accuracy, evaluation and management coding, physician coding, healthcare and physician attitudes


Physicians across the United States are burdened with the pressure of accurate coding while trying to maintain quality patient care. Despite the economic importance of coding accuracy, investigators have not reached consensus on the factors that contribute to coding errors. This study fills this gap by investigating physician characteristics that explain the variation in physician coding accuracy, specifically evaluation and management upcoding and downcoding errors. An electronic survey was distributed to 325 physicians that measured physicians’ attitudes towards risk and coding self-efficacy. Regression analysis found physicians with low self-efficacy had more conservative coding behaviors, resulting in higher incidences of downcoding. Physicians with high risk-seeking attitudes coded more aggressively, resulting in higher incidences of upcoding. This study is the first to empirically investigate physician personality characteristics that determine upcoding and downcoding behavior and suggests that physician payment policies, to be effective, must neutralize the effect of physician personality on code selection and reimbursement outcomes.