Which of the following is an example of unbundling?

Prepare for the Essentials of Healthcare Compliance Test. Improve your understanding with various flashcards and multiple-choice questions. Each question features detailed hints and explanations to enhance your readiness for the exam!

Unbundling refers to the practice of submitting multiple claims for distinct services that should be billed together as a single procedure. This often occurs in healthcare billing where a provider might split one comprehensive procedure into several separate claims or codes in order to receive higher reimbursement. By doing this, the provider can increase their overall income from a service that would typically be compensated at a lower rate as part of a bundled payment.

In this context, when a healthcare provider submits separate claims for aspects of a single collective service, it results in a process where the total cost is inflated. This practice is scrutinized under healthcare compliance regulations because it can lead to overbilling and may violate payment agreements with insurers.

The other options describe different scenarios that do not align with the concept of unbundling. For example, combining multiple codes into one invoice suggests bundling rather than unbundling, while billing for follow-up visits separately may be legitimate based on the need for continued care but does not constitute unbundling of a single procedure. Charging for procedures that were not performed is considered fraudulent billing rather than an example of unbundling.

Subscribe

Get the latest from Examzify

You can unsubscribe at any time. Read our privacy policy