What is the difference between Bundling, Partial Payment of Multiple Claims and Downcoding?
BUNDLING Bundling is an unfair devaluation of a physician’s services and occurs when a claim is submitted for two or more separate and distinct services and the insurer “bundles” them together and reimburses for only one of the services. The most common form of bundling is for insurers to ignore modifiers, especially modifier -25. In the CPT Manual, modifier -25 is a “significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service.” If a physician suspects that an insurer is inappropriately bundling services, the office staff should compare the original claim to the EOB. If the insurer is bundling modifier -25, the EOB will usually reflect that there was no payment for the initial office visit but there was payment for the secondary procedure. In these situations the EOB explanation will often state something indicating that the procedure was included in the global services or that payment was based on the p
