Medical billing can be a confusing and daunting process for patients. One term that may come up in the process is “unbundling.” Unbundling in medical billing refers to the practice of breaking down a medical service or procedure into its individual components and billing separately for each component. This practice can be used by healthcare providers to increase revenue, but is considered incorrect and possibly fraudulent billing.
Unbundling Medical Codes
Unbundling medical codes involves the use of separate billing codes to bill for each component of a service or procedure that a patient received.
Unbundling a Test into Separate Procedures: An Example
One example of unbundling in medical coding is the use of separate codes for lab tests that are typically performed together. For instance, a healthcare provider may bill separately for a basic metabolic panel (BMP) and a complete metabolic panel (CMP), even though they are often performed together. This practice of unbundling can result in a higher bill for the patient and may also violate federal laws such as the False Claims Act.
Unbundling: What Patients Need to Be Aware Of
Upcoding and unbundling are often used together in medical billing to increase revenue. Upcoding involves billing for a more expensive service or procedure than what was actually performed, while unbundling involves billing separately for each component of a service or procedure. Both practices are considered to be possibly fraudulent billing and illegal.
It is important for patients to be aware of unbundling in medical billing and to review their medical records and bills carefully. Patients should double-check that they are being billed for the correct CPT codes and the services they received were necessary and appropriate. Insurance companies also play a role in preventing unbundling by randomly auditing medical bills to ensure that providers are using the correct codes and billing for only the services that were performed.
Takeaways
Unbundling in medical billing involves billing separately for each component of a service or procedure. This practice can be used by healthcare providers to increase revenue but is considered to be fraudulent billing. Patients should stay vigilant in reviewing their medical bills and ensuring that they are being billed correctly.