What does unbundling in healthcare billing refer to?

Unbundling in healthcare billing refers to the practice of using multiple codes to bill for a single procedure. This typically occurs when a provider separates a bundled service, which should be billed under one comprehensive code, into several individual codes to maximize reimbursement.

The focus on using multiple codes instead of a single bundled code can lead to inflated billing and is considered a fraudulent practice. Since many procedures have an established bundled payment structure to account for various components of care, unbundling undermines this system and can result in higher costs for both payers and patients.

Understanding unbundling is crucial for compliance because it directly impacts the integrity of medical billing and coding practices. Accurate coding ensures that providers are reimbursed fairly for their services while preventing overbilling and protecting the organization from legal liabilities related to fraudulent claims.