Bundling Issue with Charges from a Hospital/Hospital-Owned Clinic

dreampeddler

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St. Paul, MN.
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Good Morning, Everyone!

I'm coming at this question from a payer's perspective. We have received two separate bills for lab charges. One for a 81003 from a clinic and one for a 81015 from a hospital.

The hospital owns the clinic, and both share the same federal tax number, as well as the same pay-to address. Our system wants to kick these charges out as denials, stating that they rebundle into a 81001. The provider disagrees.

Has anyone else experienced a similar situation, from either end? Did you take the same action our system/management feels is correct?

Thanks!

Jodie, CPC
 

kevbshields

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Louisville, KY
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Since both charges are from the same entity, they should appear on the same claim--no? This is problematic for payers when a variety of services are "unbundled" onto separate claim forms. This also helps the provider to see modifier issues.

Ask for the documentation and that the claims be submitted on the same form . . . this may shed some light into what is going on.
 
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