Unbundling can be utilized if a medical provider performs the same procedure on opposite sides of the body. Make sure to take note of every treatment or procedure done in physical therapy documentation.
Denville, NJ (PRWEB) November 22, 2013
“Distinguishing which procedures can be bundled and those that can’t takes practice and skill,” said Chhoda. “Practitioners who perform a service or procedure as a result of doing another can link the two, but some procedures are viewed by payers as part of a whole and aren’t eligible.
He added that practices must bill accurately and fairly, with or without the help of medical billing software, but when bundling and unbundling is warranted, practitioners can reap the benefits through additional income.
Knowing when to bundle and when to unbundle can be a difficult decision. Approval and payment is ultimately in the hands of the patient’s insurance company. Claims are submitted to clearinghouses where they’re scrubbed for errors. Chhoda noted that clearinghouse software has the ability to identify procedures that were incorrectly bundled and the payer won’t assign reimbursement.
Electronic medical records software helps immensely in the billing process. The systems can indicate when procedures are incidental to one another and when they qualify for unbundling. A second procedure that’s completed at the same time as another can’t be billed separately. Clinicians can’t bill separately for actions taken during a procedure that are essential to that service.
According to Chhoda, there are also compliance laws and regulations to consider when unbundling. ICD codes and edits must support the extra effort. Unbundling can be utilized if a medical provider performs the same procedure on opposite sides of the body. Make sure to take note of every treatment or procedure done in physical therapy documentation.
Medical billers must be in compliance with the National Correct Coding Initiative. Many payers utilize National Correct Coding Initiative edits that are employed by Medicare and Medicaid, but they may use their own editing programs that differ significantly from others. If there’s any doubt, it’s best to refer to the terms of the contract between the payer and the clinician.
Chhoda added that bundling and unbundling procedures can earn practitioners additional revenues and his new insights provide practices with essential information on how the system works. EMR software is a critical element in the process to help billers identify and define when bundling and unbundling is warranted.
Chhoda’s office can be reached by phone at 201-535-4475. For more information, visit the website at http://www.emrnews.com.
About Nitin Chhoda
Nitin Chhoda PT, DPT is a licensed physical therapist, a certified strength and conditioning specialist and an entrepreneur. He is the author of "Physical Therapy Marketing For The New Economy" and "Marketing for Physical Therapy Clinics" and is a prolific speaker, writer and creator of products and systems to streamline medical billing and coding, electronic medical records, health care practice management and marketing to increase referrals. He has been featured in numerous industry magazines, major radio and broadcast media, and is the founder of Referral Ignition training systems and the annual Private Practice Summit. Chhoda speaks extensively throughout the U.S., Canada and Asia. He is also the creator of the Therapy Newsletter and Clinical Contact, both web-based services to help private practices improve communication with patients, delivery better quality of care and boost patient retention.