Outpatient Facility Coding Alert - 2017 Issue 3
Unbundling and Double-Billing Go Hand-In-Hand with Upcoding
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Article Overview
This article covers common coding and billing compliance concerns tied to CMS payment policy, including bundling, unbundling, duplicate billing, and the role of modifiers in supporting claim accuracy. It is aimed at coders, billers, and compliance-minded practices that need a general understanding of how Medicare guidance and fee schedule updates relate to coding errors and claim denials.
Why This Topic Matters
Understanding these topics helps coding and billing teams recognize when services may be packaged together, when duplicate billing risks exist, and when documentation or modifier use may be relevant to claim processing. The article is useful for readers monitoring Medicare policy changes and practice-level compliance.
What You Will Learn
- How bundling is framed within CMS payment policy
- Why unbundling and duplicate billing are compliance concerns
- How modifiers are discussed as part of claim clarification
- Where Medicare fee schedule guidance is referenced as a resource
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Physician practice administrators
- Revenue cycle professionals
Codes Discussed
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