Chethan Sarabu, MD
Oct 25, 2024
When it comes to paying for healthcare, nothing feels straightforward. If you’ve ever had a surgery or a major medical procedure, you probably received several different bills: one from the surgeon, another from the hospital, a separate one from the anesthesiologist, and maybe even more for post-op care like physical therapy. This can make it difficult to know exactly what you’re paying for—and how much.
That’s where bundled payments come in. The idea behind bundled payments is simple: instead of getting separate bills for each part of a procedure, all the services related to that procedure are bundled together into one, upfront price. For example, if you’re having a knee replacement, the cost of the surgery, hospital stay, and follow-up care would all be included in a single, predictable payment.
But, like anything in healthcare, bundled payments aren’t perfect. There are still issues with coding errors that can complicate things. So, let’s explore how bundled payments work, the common mistakes that can pop up, and why upfront price transparency can be a real game changer for patients.
Common Coding Errors in Bundled Payments
Even with bundled payments, billing errors happen. Here are a few of the most frequent ones:
1. Services Excluded from the Bundle by Mistake
Sometimes, services that should be part of the bundle are accidentally left out and billed separately. This leads to extra, unexpected charges.
Example: After a hip replacement surgery, a patient receives a separate bill for physical therapy sessions, even though it was supposed to be part of the bundled payment.
2. Unbundling of Services
Unbundling occurs when individual services that should be grouped together in the bundle are mistakenly billed separately. This can inflate costs unnecessarily.
Example: A patient undergoing coronary bypass surgery receives separate bills for tests, anesthesia, and the hospital stay, even though they’re all supposed to be part of one bundled payment.
3. Incorrect Application of the Bundle
Sometimes, providers use the wrong billing codes for the bundled service, resulting in patients being charged for services that should have been covered by the bundle.
Example: A patient expecting bundled maternity care gets charged separately for delivery-related services due to an incorrect code.
4. Duplicate Billing
Even within bundled payments, errors like duplicate billing can occur, where a service that’s included in the bundle gets billed separately.
Example: A patient having knee surgery receives two charges for anesthesia—one within the bundle and one as a separate charge due to a billing error.
Bundled Payments Can Simplify Costs, But Stay Vigilant
Bundled payments are designed to simplify healthcare billing and give patients more predictability when it comes to costs. However, coding errors can still happen, leading to unnecessary charges. By knowing what to look out for, you can avoid common pitfalls and take advantage of the benefits bundled payments offer—especially the peace of mind that comes with knowing your costs upfront.
If you’re facing a procedure or treatment, don’t hesitate to ask your healthcare provider whether they offer bundled payments and what’s included. It could save you both money and stress in the long run.