@marty56 wrote:
@haulingthescoreup wrote:
If you're talking about unbundling in medical billing (billing for the separate components of a procedure when there is a single code that covers it all), it is illegal. If it's for Medicare, etc., it's Medicare fraud and abuse, and that can mean jail time. Think Inspector General visits.
Several years ago I had a procedure where the billing company tried to unbundle part of a procedure that I had. They tried to bill me for the difference and since the doctor was a PPO, I told them to contact my insurance company which they never did and believe me I still look at my credit report to make sure the billing company doesn't try to sneek in a collection. IMHO they new it was illegal but took a shot in getting me to pay.
We have seen collection companies try to collect debt from people that were not obligated to pay (other family members) and I am sure that there are some billing compaies that also do this.
Yes, they definitely do try, but if they have any sense at all, they won't try very long. Does your insurance company realize what the doctor's office tried to do? They're the ones with the ammo. 
It's also easy to accidentally unbundle. For instance, maybe your doctor is removing a growth from your skin. Some excisions include sewing things back up; others don't; and some vary according to how complex the sewing-back-up procedure is. You have to know which is which, and the code books don't tell you everything. Good coding software is essential to prevent accidental unbundling, because the logic can be screwy.
(Alert: don't read below if you're not comfortable with medical stuff!)
For instance, if a patient has an EGD (tube with camera sent down via the mouth all the way into the beginning of the small intestine) and a colonoscopy (tube with camera sent upwards via the rectum through the colon to the end of the small intestine) on the same day, perhaps to check for a cause of chronic anemia, they have to be coded in a way that points out that they were separate procedures. In other words, the doctor didn't start out with the EGD and keep going and going and going through an additional 20+ feet of small intestine to then do the colonoscopy. A "modifier" needs to be attached to one of the procedure codes to point out that yes, these were two separate actions. (Duh!) Otherwise, they payer would try to bundle them together and only pay for one. Then you get a bill for the second procedure. This is an example of improper bundling, not unbundling, of procedure codes.
Sorry for the graphic example. 
It's just the classic example of weirdness in procedural coding and the sort of thing that makes coders occasionally twirl around in our chairs, wondering who dreams this stuff up.
With unbundling, it's easy to get modifiers wrong and accidentally bill for two separate procedures when there should have been just one. It's also easy to be untrained, or sloppy, or to commit outright fraud.
Anyway, I'm glad you caught the unbundling on your bill!
@haulingthescoreup wrote:
Yes, they definitely do try, but if they have any sense at all, they won't try very long. Does your insurance company realize what the doctor's office tried to do? They're the ones with the ammo.
LOL they just told me not to pay it.
