Certified in Healthcare Compliance (CHC) Practice Test 2025 – Complete Exam Prep

The practice of separating claims that should be billed together is known as unbundling. Unbundling occurs when a healthcare provider intentionally divides a procedure or a set of services into multiple parts and bills them individually instead of as a single comprehensive service. This practice can lead to higher reimbursements, as each individual component may be reimbursed at a higher rate than if they were billed together. Unbundling can create compliance issues as it may violate regulatory principles that require services related to a single treatment or procedure to be billed collectively.

Understanding unbundling is important in the context of healthcare compliance because it is considered an unethical billing practice and can attract scrutiny from payers, auditors, and regulatory bodies. It is essential for healthcare providers to ensure that billing practices align with guidelines established by payers and regulatory agencies to prevent potential fraud allegations and maintain compliance.