tci Medicare Compliance & Reimbursement - 2017 Issue 3
Unbundling? Expect To Be Unpaid
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Article Overview
This article discusses the broader issue of unbundling and duplicate billing in the context of Medicare payment policy and the Quality Payment Program. It is aimed at practices, billers, and coders who need to understand how CMS guidance and fee schedule updates relate to bundled services, global periods, and potential payment denials tied to billing the same service more than once. The article also uses a urinalysis example to illustrate the type of billing overlap that can create problems.
Why This Topic Matters
Bundling and duplicate billing errors can lead to denied claims, lost reimbursement, and compliance risk. Understanding the general categories of services most likely to be bundled helps practices review billing workflows and stay aligned with CMS guidance.
What You Will Learn
- How bundled payment policy relates to Medicare reimbursement
- Why duplicate billing can create payment and compliance issues
- How CMS fee schedule guidance is used to identify bundled services
- Why practices should review billing workflows for overlapping claims
Who Should Read This
- Physician practices
- Medical coders
- Medical billers
- Revenue cycle staff
- Compliance staff
Codes Discussed
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