Bundle of trouble: How to challenge insurers' payment methods

It's well-known that managed care plans bundle codes as a way to cut reimbursements to physicians. What's less known is that physicians can do something about it.

By Robert Kazel, AMNews staff. Feb. 10, 2003.

When he hears about doctors glumly accepting the bundling of CPT codes by insurers as an inevitable part of the reimbursement game, health care consultant and former HMO executive Jim Laurenza says he considers the example of Capt. James T. Kirk of the TV show "Star Trek."

When faced with a computerized test no one had ever solved, a young and brash Kirk aced the exam by taking on the computer and rewriting the rules himself. Kirk declared he simply didn't believe in "the no-win scenario."

Like Kirk, physicians can use ingenuity and resolve to improve their relationships with insurers by confronting the health plans head-on, as well as the computers that bundle claims and shrink physicians' income, according to Laurenza, president of the Louisville, Ky.-based consulting firm Dacite Inc.

Though just beginning, progress in challenging bundling is already under way, and industry experts say more change is ahead. Relief, they predict, will happen in three ways: revision of physician contracts, sustained pressure from medical associations and scrutiny of insurer behavior in the nation's courtrooms.

Previously a senior strategist with Blue Cross and Blue Shield of Kentucky, Laurenza has no illusions about the ease of bargaining with managed care plans. "The question is, what are payers doing to hurt [physicians], and the answer is, anything they can."

Still, physicians should not make the mistake of passively accepting the same network contracts that allow insurers to bundle claims at will, Laurenza said.