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Dec 07

Physician tips for dealing with disputes about bundled charges

The constant back and forth between providers and payers when disputing bundled charges is an all-too-common scenario. The following are four tips for dealing with bundled charges:

1. Negotiate in your contract. The plan and provider should both agree for the purposes of bundling to follow Medicare’s CCI. Make sure both parties agree to these terms; otherwise, a clause can be left open to interpretation.

2. Meet with the payer. If disputes about a particular segment of bundled charges (e.g., diagnostic charges) seem to occur with more frequency, the provider should meet directly with the medical director and the payer and have a discussion about the fairness of the bundling rules.

3. Don’t let inappropriately bundled charges go unnoticed. Any time there is a discrepancy between what was received and what the provider believes is due, the provider’s in-house staff should immediately turn it over to the office manager.

4. Check your internal coding practices. It’s easy to overlook, but the incorrect use of modifiers can result in inappropriate bundling. You have to ask yourself if the bundling is occurring because the practice is not coding correctly.

About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →