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Wiki Bundled Service
- Thread starter annr420
- Start date
mitchellde
True Blue
No if the service is deemed bundled and you cannot unbundle it then the cost of the bundled procedure is part of the cost of the procedure it is bundled into.
Thank you "mitchellde" That is what I have always thought, however I am somewhat surprised that only 1 response has been posted...has this become a grey area? I thought it was clear cut - a patient cannot be billed for a service that the insurance company has already denied as "Bundled". It has been my impression (right or wrong) that to bill a patient for a code denied as "Bundled" is a form of insurance fraud.
Am I interpreting this incorrectly?
Thanks
losborn
Guest
That is correct - to bill the patient could be considered filing a False Claim as the provider has been paid according to the cobtracted amount.
Lin
CPC, CEMC, CPMA
Lin
CPC, CEMC, CPMA
CLCameron
Guest
Contracted vs. Non-contracted
If a charge is considered bundled per NCCI edits, you cannot bill that charge to either the patient, or their insurance (private or otherwise).
If a commercial insurance plan is bundling something (non-NCCI restricted) due to contractual guidelines, then a contracted provider may not make the patient responsible for said charge.
In my experience, the gray area comes into play when dealing with a non-contracted/non-par provider. If there is no NCCI edit prohibiting seperate billing, and no contract with the insurance company holding the provider to their internal edits, then it is possible for that provider to balance bill the patient for any non-covered charges/balance remaining after the insurance plan processes the claim(s), based on provider billing policies.
If a charge is considered bundled per NCCI edits, you cannot bill that charge to either the patient, or their insurance (private or otherwise).
If a commercial insurance plan is bundling something (non-NCCI restricted) due to contractual guidelines, then a contracted provider may not make the patient responsible for said charge.
In my experience, the gray area comes into play when dealing with a non-contracted/non-par provider. If there is no NCCI edit prohibiting seperate billing, and no contract with the insurance company holding the provider to their internal edits, then it is possible for that provider to balance bill the patient for any non-covered charges/balance remaining after the insurance plan processes the claim(s), based on provider billing policies.