Wiki Unbundling 36415 and labs for BCBS/State Health Plan

[jhanmer83]

The company I work for is telling me to continue to bill the venipuncture separately from the labs for BCBS/State Health Plan when we know the venipuncture is always bundled for these payers. Does this violate the code of ethics or is this potentially fraud to continue to do this?

 

[thranowski]

Venipuncture is not bundled according to NCCI edits, iirc.

 

[trarut]

Some payers have their own bundling rules for venipunctures. (Aetna is one of them.) We always billed the venipuncture (or other draw fee as appropriate) and wrote off the venipuncture when the remittance arrived. We had what we called "blanket adjustments" where we wrote an adjustment request with supporting documentation from the payer that was approved by the billing manager. That "blanket adjustment" was then referenced by the payment poster during the posting process. This way we were billing all patients & payers the same but not forcing denials we knew we couldn't overturn through the denial follow-up process. Hope this helps!

 

[thranowski]

Some payers have their own bundling rules for venipunctures. (Aetna is one of them.) We always billed the venipuncture (or other draw fee as appropriate) and wrote off the venipuncture when the remittance arrived. We had what we called "blanket adjustments" where we wrote an adjustment request with supporting documentation from the payer that was approved by the billing manager. That "blanket adjustment" was then referenced by the payment poster during the posting process. This way we were billing all patients & payers the same but not forcing denials we knew we couldn't overturn through the denial follow-up process. Hope this helps!

We have the same blanket policy. If insurance doesn't pay, we write it off.