A Coding & Reimbursement Tip -
Watch out for "The Bundle and Drop"

It's easy to miss and can create confusion as well as an inflated accounts receivable balance. We call this process the "The Bundle and Drop".

Here's how it works:

Two or more procedures are submitted to a third party payer (TPP) for payment. The TPP deletes the charges for one or more items and adds the charges to a single service. When the Explanation of Benefits (EOB) comes back to the practice the only item reported is the single item with the allowed amount. The other services provided may not be shown at all. There may be a note saying the charges for related services have been included in the basic service. The TPP bundles the charges then drops one or more procedures.

There are several problems with this, one of which is not being paid. If the person posting the payment does not pickup the bundling and adjust the balances for all the submitted charges they will stay on the patient's account. It inflates the A/R, causes needless follow-up with patients and may lead you down the wrong track in trying to follow-up with the TPP.

Here are some tips for dealing with this problem:

• Use different ICD-9 codes, if appropriate, when submitting claims. Make sure the procedure maps to the correct ICD-9 code on the claim.
• Review the definition of modifier -59 (Distinct Procedural Service). It may be appropriate to identify separate procedures this way when it involves separate sessions, incisions, organs, separate lesions, etc.
• Check EOBs carefully and compare the charge submitted to the charge reported on the EOB.
• Watch for notes on the EOB indicating the bundling.
• If the bundling is not appropriate appeal the service immediately providing your reasons why the services should not be bundled.
  
  

If the Bundle and Drop technique appears to only be for managing the payer 's costs, complain to the payer and send a copy to your medical associations, as it may be happening to others.
Request payers to leave charges alone. If they are bundling services together they can report a "zero" allowable for each of the bundled items. This is how Medicare carriers do it and so can the TPPs.

The Bundle and Drop technique is a way payers can reduce overall costs while seeming to maintain a reasonable fee schedule. Pay attention to those EOBs and take corrective action immediately when you see the problem.

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