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 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 Professional Coder, CPC,  accredited through the American Association of Professional Coders (AAPC). 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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