What exactly is "bundling"? When an insurance company combines two or more CPT codes, instead of one overall code, the modifier is usually ignored. This can reduce your accounts receivable. When bundled with code, the code is grouped together and the insurance company will only allow the fee schedule for a code they think is appropriate.
There are ways to get around the bundle. First, you need to make sure that the claim is correctly calculated on initial submission. For example, if you want to calculate an E&M code for a patient with high blood pressure, but the patient complains about knee pain and you end up with a knee pumping, then you need to make sure you use the correct modifier to indicate what you are doing. . You want to bill the E&M code, for example it is 99213 with 25 modifiers indicating that it is a separate and different service offered during the same visit. You will then use the 59 modifier to calculate the inspiratory volume of the knee for the appropriate code to indicate different program services.
It is very important to know that all the different modifiers are used correctly to get the full reimbursement for the service. It is also important to be able to read EOB correctly [interpretation of the statement of interest]. EOB can be quite complex, and it is important to understand how insurance companies handle claims.
After processing the claim and receiving the EOB, you need to make sure that the insurance company allows the two codes separately. After all, you have made an office visit to control high blood pressure, and you have made a desire to be completely independent of the office.
If the insurance company bundles your password, you should file a complaint. In many cases, if you pass the appeals process, the insurance company will reprocess the claim and split the code.
The appeal does not have to be complicated. It can be a form letter that you design, just fill in the blanks. Many operators bundle the initial processing claims because the main office does not appeal the claim. Think about how much they saved!
You may think it's not worth the appeal, but you might be surprised if you know how much you actually lost. If you have a system to archive a fairly simple process, then it won't take too much time and you can increase your accounts receivable. In my opinion, this is worth it.
Copyright 2007 - Michele Redmond
Orignal From: Bundle Health Insurance Code - Stop Claiming Loan to "Bundled" Medical Insurance
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