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Don't Overlook Coding Opportunities For Routine Healthcare Services

Greg Freeman, January 29, 2014

Another way to miss out on revenue is when a practice "self-bundles" codes that could be billed separately, White says. This happens when a practice does not bill for certain encounters or services because the biller expects those claims to be denied. But, White says, this almost always results in lost revenue because some of those claims most likely would be paid. If the insurer is denying routine claims that should be paid, that's a problem that should be addressed directly with the insurer.

"That self-bundling can really hurt you. Maybe not every claim is paid by every insurance plan, but it's those five or six times a year where you collect that are critical if you are going to maximize your revenue," White says. "If you do it, bill it. Make sure you bill for each individual line item, and let the insurer deny it if they're going to. Most of us have been told no before and we get over it, but if you don't ask you're not going to be paid."

Self-bundling can seem like an efficiency measure, he explains, because the biller avoids the time and effort of filing the claim and also any effort to appeal the denial.

"That's a trap, focusing on trying to minimize your adjustments from denied claims," he says. "Focus on maximizing the cash coming through the door, not trying to eliminate denials and adjustments."

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