Tips to Avoid Unbundling Codes

1. Visit our website: Click here Follow us: 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. Copyright © Medical Billers and Coders. All Rights Reserved Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com 1

2. Visit our website: Click here Follow us: 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: 1. Use Comprehensive Codes To avoid unbundling codes, healthcare providers should use comprehensive codes that accurately reflect the full range of services provided. Let’s 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 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 Copyright © Medical Billers and Coders. All Rights Reserved Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com 2

3. Visit our website: Click here Follow us: need to submit a corrected claim. 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. It’s 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 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. Copyright © Medical Billers and Coders. All Rights Reserved Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com 3

4. Visit our website: Click here Follow us: 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 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. MBC’s 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@medicalbillersandcoders.com or call us at: 888-357-3226. Copyright © Medical Billers and Coders. All Rights Reserved Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com 4