FRIDAY September 18, 2015:
“Fighting Commercial Bundle Denials“
Are Commercial Payors Out of Control?
When I first heard of this practice, I immediately sat down, as I was seized by vertigo. You?
Many of you may be familiar with some commercial payors issuing denials for so-called “minor medical and surgical supplies” and using CMS rule 2202.6 as the basis for the denials. (To familiarize yourself with the CMS rules, refer to Provider Reimbursement Manual 15-1, Sections 2202.6 and 2203 – included in the handouts for today.)
The rub is the idea that things like anesthesia supplies, fluids and gases are “interpreted” by the payor as “minor” and therefore “bundled” and not paid separately. It’s pretty obvious that the only reason to do so it to limit reimbursements, and makes no logical sense. Which, of course, has no bearing on what commercial payors do. Nevertheless and evidently, this practice is common and yet its use widely varies across the country, especially because every hospital negotiates its own contract, and the terms are specific to that payor and that hospital.
Robert Chacon, CPC, ICD-10 trained, and highly experienced in coding, plus HCC, HEDIS and RADV.
Chris Baggott, CEO at Medlinks, President of Healthcare Solutions Alliance, and a Certified Medical Auditor
This week, we welcome back Chris Baggott, CEO of Medlinks Cost Containment, Inc., and member of the Healthcare Solutions Alliance, LLC. Joining Chris is coding specialist Robert Chacon, who has extensive experience in many areas of coding, and has been involved with both Medlinks and the American Academy of Professional Coders (AAPC) in several recent ICD-10 implementation processes & training projects. Chris and Robert will explain how they recently were successful in arguing with a payor to stop bundling so many line items billed under Revenue Code 270.
We will be discussing with Chris and Robert:
- Where is the best place to look for these issues?
- Do the payors just spring it a hospital in denials?
- Do they notify providers of changes in policy like this?
- Do they just deny and don’t even explain?
- Who (in the hospital) winds up trying to unravel this Gordian Knot?
- What steps should a hospital take to attempt to prevent this?
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