Tips to Avoid Unbundling Codes

1
(No Transcript)
2
Tips to Avoid Unbundling Codes
What is Unbundling Codes? Unbundling codes in
medical billing refers to the practice of
separately billing for individual components of a
medical procedure or service, rather than billing
for the complete procedure or service as a single
entity. This practice can result in higher
payments to healthcare providers and higher costs
for patients and insurers. For example, imagine a
patient receives a single medical service that
includes a group of tests. If the provider bills
for each test separately rather than billing for
the single service that includes all of the
tests, this is considered unbundling. Unbundling
can be deliberate or unintentional. Deliberate
unbundling is fraudulent and illegal, while
unintentional unbundling may occur due to errors
in coding or billing. The Centers for Medicare
Medicaid Services (CMS) has developed specific
guidelines to prevent unbundling and ensure
accurate coding and billing practices. These
guidelines include instructions for when it is
appropriate to bill for bundled services and when
it is necessary to bill for individual components
separately. Unbundling codes can have significant
financial implications for patients and insurers.
It is important for healthcare providers to
accurately bill for services to ensure fair and
appropriate compensation and to avoid potential
legal and financial penalties for fraudulent
billing practices.
3
Tips to Avoid Unbundling Codes

• Tips to Avoid Unbundling Codes
• Unbundling codes could result in incorrect or
  excessive reimbursement and is considered
  fraudulent. Here are some tips to avoid
  unbundling of codes
• Use Comprehensive Codes
• To avoid unbundling codes, healthcare providers
  should use comprehensive codes that accurately
  reflect the full range of services provided.
  Lets discuss an example of how a healthcare
  provider might use comprehensive codes to avoid
  unbundling codes. A patient comes in for a
  comprehensive physical exam, which includes a
  routine check-up, a complete blood count (CBC),
  and a lipid panel. Instead of billing for each
  service separately, the provider would use a
  comprehensive code that encompasses all of these
  services.
• For example, they might use the code 99385, which
  represents a comprehensive preventive medicine
  evaluation and management of a patient including
  an age and gender-appropriate history,
  examination, counseling/anticipatory
  guidance/risk factor reduction interventions, and
  the ordering of laboratory/diagnostic procedures,
  established patient 18-39 years of age. By using
  a comprehensive code like this, the provider can
  ensure that they are billing for the full range
  of services provided, without risking

4
Tips to Avoid Unbundling Codes
potential unbundling issues. It also helps to
simplify the billing process and avoid confusion
for both the provider and the patient. 2.
Understand National Correct Coding Initiative
(NCCI) Edits Make sure you understand the codes
and their components before reporting them.
Familiarize yourself with the National Correct
Coding Initiative (NCCI) edits that provide
guidance on which codes can and cannot be billed
together. The National Correct Coding Initiative
(NCCI) is a program developed by the Centers for
Medicare Medicaid Services (CMS) to prevent
improper payment of Medicare claims. NCCI edits
are sets of codes that are used to determine if a
procedure or service is appropriate to be billed
together. The NCCI edits contain pairs of codes,
referred to as Column One and Column Two
codes. The Column One code is the primary code or
procedure being performed, while the Column Two
code is a secondary code or procedure that is
typically not performed separately from the
Column One code. When a claim is submitted with
both a Column One and Column Two code, the NCCI
edits will check to see if the codes are allowed
to be billed together. If the codes are not
allowed to be billed together, the NCCI edits
will reject the claim, and the provider will need
to submit a corrected claim.
5
Tips to Avoid Unbundling Codes
For example, if provider bills for both a lumbar
puncture (Column One code) and a spinal tap
(Column Two code), the NCCI edits will reject the
claim because these two procedures are considered
to be the same procedure and cannot be billed
separately. Its important for healthcare
providers and billing staff to be familiar with
the NCCI edits to ensure that claims are
submitted correctly and avoid potential penalties
or fines for improper billing. 3. Regularly
Reviewing Claims Source freepik.com
6
Tips to Avoid Unbundling Codes
Regularly reviewing claims is an important
practice to avoid unbundling codes. As disused
earlier, unbundling is a practice of separately
billing for two or more component parts of a
procedure when a single code exists that includes
all of the components. This practice can lead to
overbilling and can result in fines and
penalties. To avoid unbundling, healthcare
providers should review their claims before
submitting them to ensure that they are billing
appropriately for all components of a procedure.
This review should include checking that all
services provided are accurately represented by
the codes billed and that the codes do not
overlap or duplicate services. Additionally,
healthcare providers should stay up-to-date with
coding changes and guidelines to ensure that they
are billing correctly. They should also ensure
that their staff is trained and knowledgeable in
proper coding and billing practices. Overall,
regularly reviewing claims and staying current
with coding changes and guidelines is essential
to avoid unbundling codes and ensure accurate
billing practices. 4. Seek Professional
Assistance Unbundling codes is fraudulent and
illegal, as it misrepresents the services that
were actually provided, and can result in
overbilling and improper payments. If a
healthcare provider is found to have engaged in
7
Tips to Avoid Unbundling Codes
unbundling codes in medical billing, they may
face legal action from both government regulators
and private insurance companies. This can include
fines, penalties, and exclusion from
participation in government healthcare programs
such as Medicare and Medicaid. In addition,
patients who have been affected by fraudulent
billing practices may also have legal recourse to
seek damages or compensation for their
losses. To avoid unbundling codes, you need
professional assistance from coding experts
like Medical Billers and Coders. MBC is a
healthcare revenue cycle management company that
specializes in medical billing, coding, and
practice management services for healthcare
providers. As a medical coding expert, MBC is
trained and experienced in accurately coding
medical procedures, diagnoses, and treatments for
billing purposes. Our coders have a thorough
understanding of medical terminology, anatomy,
and physiology, as well as the rules and
regulations governing medical billing and
coding. MBCs team of medical coding experts
works closely with healthcare providers to ensure
that all medical services are accurately coded
and billed. To know more about our billing and
coding services, email us at info_at_medicalbillersa
ndcoders.com or call us at 888-357-3226.