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

Health Insurance - Bundling healing guarnatee Codes - Stop Loosing Money To "Bundled" healing 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 schedule allowance for the one code that they feel is appropriate.

What I said. It just isn't in conclusion that the true about Health Insurance. You look at this article for facts about what you need to know is Health Insurance.

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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 preliminary submission. For example, if you are billing for an E&M code for a sick person who comes in with high blood pressure but the sick person 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 precise 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 cut off and inescapable service provided during the same visit. Then you would bill for the aspiration of the knee joint with the suitable code using a 59 modifier to indicate a inescapable procedural service.

It is quite needful to know the allowable use of all the different modifiers to get full refund for your services. Also as foremost is the ability to read an Eob (explanation of benefits statement) correctly. Eobs can be fairly complicated and it is foremost to understand what the guarnatee firm did with the claim.

When the claim is processed and you receive the Eob you need to make sure the guarnatee firm allowed both codes separately. After all, you did an office visit to administrate to high blood pressure and you did the aspiration which was thoroughly cut off 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 through the appeal process.

The appeal does not have to be complicated. It can be a form letter that you manufacture where you just need to fill in the blanks. A lot of carriers bundle the claims on preliminary 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 nothing else but lost over time. If you have a system in place to file the appeals that is a fairly easy 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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