Adjusters and examiners working on your automobile no-fault and workers’ compensation claims have a myriad of tasks assigned to them. Chief among those tasks is taking care of the claimant and helping to hold down claim costs while simultaneously navigating the complexities of the claim’s administration process. When administering those claims, is bundling something that your company needs to be concerned about?
The quick answer is that bundling is an area that insurance companies do need to be concerned about. The longer, more detailed answer begins with a closer look at the Healthcare Common Procedure Coding System, or HCPCS, as it is more commonly known as within the insurance industry. These procedures codes submitted on invoices from providers should be reviewed on every claim to ensure accuracy. However, the sheer number of codes in use makes it extremely difficult to identify inaccurate codes if they are used on a provider invoice.
The complexity of HCPCS alone is a major challenge for insurance companies since it takes time to have adjusters and examiners review codes for accuracy. Further complicating the matter is a process practiced by some providers called unbundling. Essentially, this process is one where providers will intentionally use multiple procedure codes when one would be more accurate and more cost-effective.
One of the most common examples of this in the insurance industry is when a wheelchair has been prescribed for claimant usage. Generally, a wheelchair includes multiple components like armrests and footrests. Providers that practice unbundling will use a HCPCS code for each of the components and bill insurance companies for these individual items.
This method results in higher costs to the insurance company because it utilizes multiple codes. There is a more appropriate procedure code that encompasses the typical components of a wheelchair. Due to the volume of codes within HCPCS, it is completely possibly that an adjuster reviewing an unbundled invoice may not realize the wheelchair would be less expensive when coded properly. Bundling these components together under one procedure code is the best practice.
Unbundling typically isn’t an isolated incident impacting only one or two claims and it is not an uncommon provider practice. Unfortunately, this results in increasing costs to insurance companies who are not as familiar with the benefits of bundling. At the end of the day, bundling is most certainly something that your insurance company needs to be concerned about because it directly impacts your bottom line.
For additional information on how your company can partner with Northwood, a third-party administrator well versed in bundling, and help reduce costs associated with administering claims, please call to schedule a meeting with Rosanne Brugnoni at 586-755-3830 ext. 3771.Leave a reply →