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

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

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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 convention 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 colse to bundling. First you need to make sure you are billing the claim properly on the first submission. For example, if you are billing for an E&M code for a inpatient who comes in with high blood pressure but the inpatient 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 definite 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 isolate and positive aid in case,granted during the same visit. Then you would bill for the aspiration of the knee joint with the appropriate code using a 59 modifier to indicate a positive procedural service.

It is quite valuable to know the permissible use of all the distinct modifiers to get full repayment 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 company did with the claim.

When the claim is processed and you receive the Eob you need to make sure the insurance company allowed both codes separately. After all, you did an office visit to conduct to high blood pressure and you did the aspiration which was wholly isolate 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 straight through the appeal process.

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

You may think that it's not worth the time to appeal but you may be surprised if you knew how much money you assuredly lost over time. If you have a theory 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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