Wiki How to record bundled services

[mauadajar]

Hello. I recently called Medicaid to ask why my G0101 was not paid. They said that it is bundled with the preventive visit.

I would like to have a record of what we did, for example, pap smear and pelvic breast exam, even if the payer considers it as bundled or not covered. What is your common practice in a case like this?

Do you not bill the codes if you know that they wont get paid? Or do you bill it anyways, then write it off?

 

[s_harris14]

Hello!

I would advise against billing the code on the claim when you know it is a bundled service as "unbundling" is defined by CMS as fraud. Also, billing the code with the intent to write-off isn't a reliable solution. The insurance payer's edit software does not always catch the unbundled service and you could still receive payment for the code that you expected to receive a denial for. Then, you would have to deal with recoupments/refunds, which is never a pleasant experience.

My suggestion would be to build an edit within your practice management software (if an option) that prohibits you from billing bundled services together. This acts as a 2nd layer of protection/defense.

Your practice management software may also let you build administrative codes that you could add to track the complete service that was performed at the encounter without billing the service to the payer. I don't have a lot of first-hand experience with this, but I have seen it before so maybe the support staff for your software program could elaborate on that option.

I hope that helps!
-Stephanie Harris, CPB