Bundling medical assurance Codes - Stop Loosing Money To "Bundled" medical assurance Claims

Insurance Claims - Bundling medical assurance Codes - Stop Loosing Money To "Bundled" medical assurance Claims

Good morning. Now, I learned about Insurance Claims - Bundling medical assurance Codes - Stop Loosing Money To "Bundled" medical assurance Claims. Which could be very helpful in my experience so you. Bundling medical assurance Codes - Stop Loosing Money To "Bundled" medical assurance Claims

What exactly is "bundling" anyway? It is when an insurance carrier combines two or more Cpt codes, substituting one overarching code, often ignoring modifiers along the way. This custom can cut down on your receivables. When codes are bundled, the codes are grouped together and the insurance carrier will only allow the fee program discount for the one code that they feel is appropriate.

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There are ways to get around bundling. First you need to make sure you are billing the claim properly on the introductory submission. For example, if you are billing for an E&M code for a outpatient who comes in with high blood pressure but the outpatient is also complaining of knee pain and you end up doing an aspiration of the knee joint, then you need to make sure you use the exact modifiers to indicate what you are doing. You want to bill the E&M code, say it is a 99213, with a 25 modifier to indicate that it is a detach and clear service provided during the same visit. Then you would bill for the aspiration of the knee joint with the proper code using a 59 modifier to indicate a clear procedural service.

It is quite significant to know the permissible use of all the different modifiers to get full reimbursement for your services. Also as foremost is the potential to read an Eob (explanation of benefits statement) correctly. Eobs can be fairly complex and it is foremost to understand what the insurance business did with the claim.

When the claim is processed and you receive the Eob you need to make sure the insurance business allowed both codes separately. After all, you did an office visit to conduct to high blood pressure and you did the aspiration which was thoroughly detach from the office visit.

If the insurance carrier bundles your codes you should file an appeal. In many cases the insurance carrier will reprocess the claim and unbundled the codes if you go through the request for retrial process.

The request for retrial does not have to be complicated. It can be a form letter that you establish where you just need to fill in the blanks. A lot of carriers bundle the claims on introductory processing because the majority of offices will not request for retrial the claim. Just think how much money they save!

You may think that it's not worth the time to request for retrial but you may be surprised if you knew how much money you assuredly lost over time. If you have a system in place to file the appeals that is a fairly uncomplicated process it won't take much time and you can increase your receivables. In my opinion, it is worth the effort.

Copyright 2007 - Michele Redmond

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