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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"Medical Management Online saves time and money. Their excellent and complete file summaries permit me to spend more my time explaining in detail the justifications for my opinions. I can more swiftly review a complicated medical record because of the excellence of their summaries. I do not have to spend a lot of time repeating the major points noted in each patient contact. Their transcription service is fast and accurate permitting rapid editing of my reports. The superior differences between Medical Management Online and other services is striking. Frankly, I look forward to working on the next case each time."

- Portland Neurosurgeon