Billing and Coding

A billing and coding review (BCR) assures that you are not over-paying for services that may have been improperly coded, billed, documented, or priced. Medical Management Online highly recommends thorough evaluation of all significant surgery or injection billings, as well as cases in which the highest level of service is being billed, pricing seems excessive, or unbundling is suspected.

Healthcare providers who bill insurance companies demonstrate varying degrees of competence in coding and billing their services. In some cases, providers may be in violation of Current Procedural Terminology (CPT) billings conventions, National Correct Coding Initiative (NCCI) protocols and other billing and coding guidelines and regulations. Provider schedules also may not reflect applicable fee schedules, or may be inconsistent internally or with relative value units (RVUs).

In a billing and coding review, a Certified Coding Specialist will evaluate the billings and documentation submitted and develop a report that summarizes findings related to billing, coding, and pricing. Recommendations are made for coding corrections and appropriate price adjustments.

At MMO, all of our BCRs are conducted by a certified coding specialist accredited through the American Health Information Management Association (AHIMA). This is a national certification that enables MMO’s coding specialists to make reimbursement recommendations based on well-established CPT coding protocols. These protocols are universally employed throughout the healthcare industry.

 

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"I have been working with Medical Management Online for almost 15 years. In that period of time the support service has been superb. They have been very helpful to me if I require additional information and the schedulers completely coordinate with my schedule. The quality of the QA review of the reports has been excellent. I have never had an independent medical evaluation report reflect anything other than the dictation I provided. "

- Eric Smith, MD, Whatcom Occupational Health