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

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

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What exactly is "bundling" anyway? It is when an guarnatee 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 guarnatee carrier will only allow the fee program allowance 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 first submission. For example, if you are billing for an E&M code for a patient who comes in with high blood pressure but the patient 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 spoton 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 inescapable aid provided while 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 inescapable procedural service.

It is quite principal to know the allowable use of all the distinct modifiers to get full refund for your services. Also as prominent is the capability to read an Eob (explanation of benefits statement) correctly. Eobs can be fairly complex and it is prominent to understand what the guarnatee company did with the claim.

When the claim is processed and you receive the Eob you need to make sure the guarnatee company allowed both codes separately. After all, you did an office visit to carry on to high blood pressure and you did the aspiration which was thoroughly isolate from the office visit.

If the guarnatee carrier bundles your codes you should file an appeal. In many cases the guarnatee carrier will reprocess the claim and unbundled the codes if you go straight through the petition process.

The petition 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 first processing because the majority of offices will not petition the claim. Just think how much money they save!

You may think that it's not worth the time to petition but you may be surprised if you knew how much money you easily lost over time. If you have a system in place to file the appeals that is a fairly simple 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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