What is Bundling in Medical Billing

Unlike balance billing, coding, insurance verification, and provider credentialing, etc, bundling in medical billing is the most complex type of billing. Incorrect bundling tends to result in rejected claims and delayed reimbursement. Therefore, it is important to understand the basics of bundling to make the process hassle-free and efficient.

Definition of Bundling

Bundling refers to the process of combining two or more medical procedures under a single Current Procedural Terminology (CPT) code for reimbursement purposes. The medical procedures combined in bundling are considered a single service as they are performed together. In this case, the first procedure is likely to result in another procedure.

The Need for Bundling

There are times when a Medicare or Medicaid patient visits a doctor for consultation due to severe pain or any other health issue. After examining the patient, the doctor may suggest a diagnostic test like x-ray, MRI, and blood test, etc. After receiving the reports the doctors identify the issue and proceed to perform the required procedure. Once the procedure is over the doctor bills the specific diagnostic test and the procedure under a single code rather than billing them separately.

For example, if a patient visits a hospital for a bone x-ray and the doctor finds a broken bone then both of these procedures may be combined together under a single CPT code. Similarly, if a medical condition is diagnosed via MRI then the procedure for that condition and the MRI service will be combined together under a single CPT code while billing.

Bundling two or more codes is a skill that is attained by practice. A good doctor knows which procedures can be bundled and which modifier should be used (if required).

Purpose and Benefits of Bundling

The purpose of bundling is to reduce the number of bills that need to be sent out to the insurance payer. Bundling multiple procedures helps in reducing the number of bills that are billed and collected.

There are two major benefits of bundling:

• Less amount of Administrative Work: Since bundling reduces the number of bills it suffices to say that the doctor will have more time to treat other patients. With less administrative work the doctor may increase his/her RVU points by being more productive.
• One Bill One Amount: Bundling helps both health care providers and insurance payers to make the reimbursement process hassle-free by reducing the multiple bills. Rather than processing multiple bills and various amounts, the insurance payer is free to process a single bill for a single amount.

Avoiding Incorrect Bundling

As mentioned earlier bundling is a complex process that requires the knowledge of medical legalities. Lack of knowledge of medical legalities like coding (CPT codes), modifiers, and billing forms, etc may result in incorrect bundling that can affect the revenue cycle of the health care provider. Therefore, it is imperative to avoid errors while combining codes. The best way to avoid incorrect bundling is to outsource medical billing and coding services from a renowned medical billing and collection company. The trained medical biller and coder will assist the doctor to bundle procedures under a single CPT code by using his/her medical coding knowledge.