Bundling sickness Codes – Stop Loosing money in the ‘package’ Medical insurance claims

What exactly is the ‘package’ anyway? Is when an insurance carrier for two or more CPT codes, replacement of a comprehensive code modifiers are often ignored by the roadside. This practice may be cut in the claims. When the code in the package, the codes are grouped together, and the insurance carrier will only allow the charges to support a code that they feel is appropriate. There are ways to get around package. First, you must make sure that the billing in accordance with the original claim submission. For example, if billing for E & M code for the patient who comes to high blood pressure, but the patient complained of knee pain, and you can do at the end of the aspiration of the knee joint, then you must make sure appropriate modifiers are used to indicate what you are doing . You want to bill the E & M code, he said that a 99,213, a 25 modifier to indicate that it is a separate service during the same visit. Then account for the pursuit of the right knee joint, using the code modifier 59 indicates the specific procedural services. Enough to know the proper use of all the various modifiers that the total compensation for the service. It is also important is the ability to read the EOB (explanation of benefits statement) correctly. EOBs also quite complicated, and it is important to understand that the insurance company also made the claim. When the application is processed and you receive the EOB must be certain that the insurance company is permitted both codes separately. After all, you manage an office visit to your high blood pressure and the aspiration of which is completely separate from the office visit. If the insurance carrier packages the code you may lodge an appeal. In many cases, the insurance carrier to process the request, and by separating the code, if you go through the appeals process. The appeal should not be difficult. It can be a circular that the development, which simply must be filled in the blanks. Many carriers, the initial batch of claims processing, because most of the office will not appeal the claim. Just think how much money! You may think that it’s not worth the time to appeal, but it may be that surprised if you knew how much money is actually lost over time. If you have a system to file the appeals, that a relatively simple process that does not take long and receivables increase. In my opinion, it is worth the effort. Copyright 2007 – Michele Redmond

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