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

1500 Health Insurance Claim Form - Bundling medical insurance Codes - Stop Loosing Money To "Bundled" medical insurance Claims

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What exactly is "bundling" anyway? It is when an assurance carrier combines two or more Cpt codes, substituting one overarching code, often ignoring modifiers along the way. This custom can cut down on your receivables. When codes are bundled, the codes are grouped together and the assurance carrier will only allow the fee agenda allowance for the one code that they feel is appropriate.

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1500 Health Insurance Claim Form

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 outpatient who comes in with high blood pressure but the outpatient 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 literal, 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 inevitable assistance in case,granted 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 inevitable procedural service.

It is quite essential to know the proper use of all the dissimilar modifiers to get full refund for your services. Also as leading is the quality to read an Eob (explanation of benefits statement) correctly. Eobs can be fairly involved and it is leading to understand what the assurance company did with the claim.

When the claim is processed and you receive the Eob you need to make sure the assurance 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 completely cut off from the office visit.

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

The motion does not have to be complicated. It can be a form letter that you invent 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 motion the claim. Just think how much money they save!

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