Wiki Unbundling for statistical reasons

[kparkhurst]

Has anyone heard of practices purposely unbundling surgical charges just to track statistical data? Our practice may be interested in doing this so as to be able to negotiate better rates with the insurance companies. I am extremely uneasy with this practice. Can anyone point me in the direction of some kind of documentation to make my case? They don't seem to want to listen that even if they expect to get denied and write off the charge, it is still wrong to bill for the service.

 

[kevbshields]

For statistical data, you should be using the practice management software. I'm certain that patients who present for follow-up during the global are assigned 99024. Although that "bill" is never sent out, it would provide exactly the same sort of data that your providers seem to want. On the front end of the global surgical package, hospital admissions, etc are only rarely going to generate their own charge, so those should be fine as is (e.g., -25 or -57 modifier instances).

See if you can find out what their designs are specifically. I'm not sure how they're going to generate better rates by counting follow-up visits, but maybe I'm being presumptive. Fee free to private message me if we need to discuss data management ideas.

Good luck. I agree with your reservations.