In many ways, a Treatment Audit is a combination of a Medical Peer Review and a Billing/Coding Review. In this, we combine the knowledge and expertise of a medical provider and that of a certified billing and coding specialist. The medical provider of chosen specialty reviews the records in detail and decides, based on the records and his or her expertise, what specific treatment is considered reasonable, necessary and related to the claim in question. After this is completed an MMO certified billing and coding specialist takes these conclusions and conducts an analysis of the medical billings. This results in a recommended reimbursement allowance, expressed in an exact dollar amount by provider.
This service is best utilized in addressing whether treatment rendered and billed was reasonable and necessary, whether the medical records document the need for, and/or the performance of, the treatments billed, and supported by the clinical documentation, and whether billings submitted comply with CPT billing protocols. Fee schedule maximum allowances are identified when applicable.
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"In my opinion, MMO has been one of the few vendors that not only exhibits professionalism, efficiency, and consistent communication, but also does this on a routine basis which ensures an easy IME process for both me as a PIP adjuster and my insureds."
- Insurance Claims Adjuster