Recently a private consultant – the colleague of a current client in fact – called me with a problem. Sadly it was a problem very much of their own making!
In an effort to increase fees, the consultant had decided that a surgical episode should be billed as follows: AB1234 £640 and CD2468 £75. So the total fee = £715.00 and on January 10th, 2022 the insurance company was sent an invoice for £715.0. And promptly proceeded to reject it.
The fee for the AB1234 was and still is correct. But with this particular insurance company offering 50% of a second code, the CD2468 fee was wrong to start with. It should not have been £75. It should have been £37.50. Great. Save the invoice would still have been rejected. Why this time?
If the private consultant had checked they would have discovered that this second CD2468 code was deemed by the insurance company to be part and parcel of the AB1234 procedure. Thus it was never going to get paid anyway and it was deemed unbundling to submit an invoice and charge for both items.
Skip forward to February, 2022. The consultant – or more accurately his long-suffering secretary – has called, emailed and written to the insurance company because the consultant is still unpaid the £640 for the AB1234.
Hence the phone call to MHM.
For once even I couldn’t do anything about the multi-code element. It very clearly states on the insurance company website that a consultant cannot invoice a CD2468 alongside an AB1234. In fact, it also says so on the CCSD website. It is deemed unbundling to do so. The bottom line is that from October 2021 to January 2022 the consultant has been £640 out of pocket. MHM called the insurance company and has confirmed the original invoice has now been canceled and re-submitted an invoice for an AB1234 £640.00. It is being paid this month too.
Moral of the story?
You will NOT uplift your fee by charging the wrong amount and you most definitely NOT uplift your fee by unbundling.