Bundling is by far the most complex type of medical billing; it is more complicated than balance billing, coding, insurance verification, provider credentialing, and so forth. Where bundling is incorrect, claims will simply be denied, and reimbursements are delayed. Hence, it becomes mandatory to understand the principles of bundling for the process to be painless and efficient.
What is Bundling?
Bundling is nothing but bringing two or more medical procedures under one Current Procedural Terminology or CPT code for the reimbursement of a single treatment process. The procedures that have a single CPT code are rendered as one service since they are to be done together. The first procedure will either lead to the need for the second within the same procedure episode; for instance, the first procedure is likely to result in another procedure.
Types of Bundling in Medical Billing
Understanding the different types of bundling is crucial for accurate medical billing:
Mutually Exclusive Bundling: This occurs when two procedures cannot reasonably be performed together during the same patient encounter. For example, a limited and comprehensive evaluation cannot be performed simultaneously on the same organ system.
Column 1/Column 2 Bundling: Also known as the Correct Coding Initiative (CCI) edits, this type of bundling involves two columns of codes where Column 2 codes are generally included in Column 1 codes. Healthcare providers must understand these relationships to avoid improper unbundling.
Comprehensive/Component Bundling: This involves combining a major procedure (comprehensive code) with its related minor procedures (component codes) that are integral to completing the main service
The Need for Bundling
At times, a patient coming under Medicare or Medicaid for consultation with the doctor may complain of severe pain or some health issues he/she is suffering from. The physician on examination of such a patient might require him/her to undergo certain diagnostic tests, such as X-ray, MRI, blood test, etc. After the doctor receives reports, he/she identifies the issue and performs the required procedure. On completion of the same, the doctor bills both the diagnostic tests and the procedure under a single code rather than billing them separately.
When a patient goes to a hospital-situated facility for a bone X-ray and then at the hospital, it is revealed that the same bone might be fractured, the two services can be linked by one CPT code. MRI has also been a source of illness-confirming diagnosis: in this regard, the service for an illness in question and the MRI will then be billed as one CPT code. These are just a few of the members of those thousands of procedures defined in CPT as combined.
NCCI Edits and Their Impact
The National Correct Coding Initiative (NCCI) played a key role in the integration process. The fix is designed to promote sound encryption methods. And to limit incorrect encryption that leads to improper payments. Highlights include:
Modifiers in Bundling
Proper use of modifiers is essential when certain procedures need to be unbundled. Common modifiers include:
Modifier 59: Used to indicate that a process or service is different from other services performed on that day.
Modifier 25: When separately identifiable critical assessment and management services are performed.
Modifier 51: Specify steps that are done in a single session.
Modifier 26: Unusual non-overlapping services
Combining two or more codes is a skill gained through practice. A good doctor knows that.
Can various processes be together and what type of transformer should be used (if necessary)?
Purpose and Benefits of Bundling
The goal of the pooling is to reduce the number of bills sent to insurance companies. Reduce the number of invoices made and collected with connected middleware for different processes.
Some of the advantages of bundling are:
Common Bundling Challenges and Solutions
Healthcare providers often face several challenges when implementing bundling:
Avoiding Incorrect Bundling
As mentioned earlier bundling is a complex process that requires the knowledge of medical legalities. Lack of knowledge of medical legalities like coding (CPT codes), modifiers, billing forms, etc may result in incorrect bundling that can affect the revenue cycle of the healthcare provider. Therefore, it is imperative to avoid errors while combining codes. The best way to avoid incorrect bundling is to outsource medical billing and coding services from a renowned medical billing and collection company. The trained medical biller and coder will assist the doctor in bundling procedures under a single CPT code by using his/her medical coding knowledge.
Conclusion
Medical billing bundling is a crucial yet complex component of healthcare revenue management. While it requires meticulous attention to coding guidelines and regulatory compliance, effective bundling significantly streamlines billing processes and improves reimbursement efficiency. Healthcare providers can optimize their bundling practices through:
As healthcare transitions toward value-based care models and embraces new technologies, mastering bundling practices becomes increasingly important. Whether managed in-house or outsourced, proper bundling remains essential for maintaining an efficient revenue cycle and ensuring optimal reimbursement while delivering quality patient care.
