Which option describes Unbundling?

Which option describes Unbundling?

• A. Billing separately for services that should be bundled; Billing exam & manipulation separately when they are part of a single visit package
• B. Paying fees for referrals
• C. Referring Medicare patients to an MRI machine you own
• D. Billing for a more expensive service than performed

Answer: (A)

Unbundling is billing separately for components that are normally billed as a single bundled service. In a single visit, the exam and the manipulation are typically part of one package, so billing them as separate line items goes beyond the intended bundled charge. This practice inflates charges and violates payer rules, which is why it’s considered unbundling. The option that describes billing independently for parts that should be bundled captures this behavior exactly. Other choices describe different improper practices: paying fees for referrals relates to kickbacks or anti-kickback concerns; referring Medicare patients to an MRI you own is self-referral and regulated under Stark/anti-kickback laws; billing for a more expensive service than performed is upcoding, not unbundling.

Unbundling is billing separately for components that are normally billed as a single bundled service. In a single visit, the exam and the manipulation are typically part of one package, so billing them as separate line items goes beyond the intended bundled charge. This practice inflates charges and violates payer rules, which is why it’s considered unbundling. The option that describes billing independently for parts that should be bundled captures this behavior exactly.

Other choices describe different improper practices: paying fees for referrals relates to kickbacks or anti-kickback concerns; referring Medicare patients to an MRI you own is self-referral and regulated under Stark/anti-kickback laws; billing for a more expensive service than performed is upcoding, not unbundling.