Medical Coding and Billing are fundamental components of the U.S. Healthcare Revenue Cycle Management that ensures Patients and Health Insurance organizations reimburse Providers for services delivered.
Medical Coding Review is the process of evaluating medical coding accuracy to ensure healthcare providers receive appropriate reimbursement for the services they provide.
Medical Coding involves accurate assignment of medical codes from three distinct but interconnected coding systems, namely, CPT® (Current Procedural Terminology), ICD (International Classification of Diseases), and HCPCS (Healthcare Common Procedure Coding System) to assign diagnoses and medical procedures. Medical coding audits, both internal and external, ensure that healthcare practitioners and organizations have the proper policies and procedures in place to achieve quality medical coding and avoid recoupment of payment. Accurate medical coding plays an essential role in healthcare information management and overall quality of care. Improper coding can result in underpayment, overpayment, denial of payment, and potential audit risks for procedures performed by the practitioner.
Quandary Peak’s Certified Medical Coding Experts have specialized training in medical terminology, coding guidelines, and regulatory requirements. They use coding manuals and analytical software to identify errors and discrepancies and ensure that all codes are complete, accurate, and consistent with the patient’s medical records.
Medical Billing Review is the process of auditing and analyzing medical bills to ensure accuracy and completeness. It typically involves reviewing claims for different types of errors, including errors in coding, up-coding, unbundling errors, data entry errors, duplicate billing and discounts not applied, and verifying that services provided by healthcare providers were billed correctly and accurately. The goal of medical billing review is to identify and correct any mistakes or discrepancies before submitting claims to insurance companies for reimbursement.
Procedure and diagnostic codes are updated on an annual basis and must be monitored continuously to ensure they are being assigned and used appropriately. With help from our Certified Medical Billing Expert professionals, a practice could save thousands of dollars in billing errors, legal fees, and penalties or fines due to improper billing and coding practices.
Our Certified Medical Coding Experts have specialized training in regulatory requirements
- Current Procedural Terminology (CPT®)
- International Classification of Diseases (ICD)
- Healthcare Common Procedure Coding System (HCPCS)
- Claims and remittance data (e.g., X12)
- Inpatient and Outpatient Billing
- Electronic Health Records
- Revenue Cycle Management
Specialized Procedures like Medical Coding & Billing Require a Trusted Advisor
Our Health IT experts have fostered trusted relationships with credible and experienced medical specialists throughout the healthcare space.
What We Do
Medical Billing Expert Witness
- Opinions on Medical Billing, Medical Coding, and Usual, Customary, and Reasonable (UCR)
- Expert Witness Testimony
- Expert Witness – Consulting, Retention, and Referral
- Personal Injury Billing
- Billing Practices, Compliance
- Excessive Billing
- Healthcare Billing
- Detect billing errors to prevent excessive costs to patients
- Line-by-line examination, charges are reviewed to confirm compliance with current national fee guidelines
- Use analytics tools and software to investigate medical bills based on the geographic practice cost index and various physician fee schedules
Corporate Integrity Agreements (CIAs) Engagement Advisors
- Healthcare Compliance
- Comprehensive CIA
- Federal Healthcare Programs
- Healthcare Programs Overpayment
- Independent Review Organization
- Nationally Recognized Coding Certification
- Self-Disclosure Protocol
- Reportable Event
- Excluded Provider
- Terms of CIA
- Failure to Comply with CIA
- Report to OIG
Meet Some of Our Software Experts
Dr. Jae Young Bang is a senior computer scientist and software technology consultant with a decade of experience in software engineering. He currently serves as a consultant and source-code reviewer in software litigation including patent/copyright infringement and breach-of-contract matters, and also as a researcher in software architecture design and analysis.
Ray Chiang is a software consultant and code analyst involved in technologies related to systems engineering, digital media, embedded system, consumer electronics, and industry-standard development. He is skilled in source code review and reverse-engineering.
Josh Mathew serves as a consultant and source-code analyst in patent litigation, copyright infringement, and breach-of-contract matters. With a background in mechanical engineering, a minor in computer science, and a data science certificate, he has the ability to simplify complex concepts for non-technical audiences.
Isaac Pflaum has more than a decade of experience as a scientist, attorney, and consultant to Fortune 100 tech companies and government agencies. He serves as an expert witness in software-related litigation such as patent infringement and breach-of-contract matters.
Dr. George Edwards has more than twenty years of experience as a scientist, engineer, and technical consultant to academic research labs, government agencies, and technology companies, and he has served as a software expert in various litigation contexts, including more than fifty patent infringement cases.
Award-winning computer scientist and software engineer Dr. Iman Sadeghi specializes in analyzing complex software systems, evaluating software production quality, and elucidating software functionalities to legal professionals. Iman’s employment journey features prestigious organizations such as Google, Walt Disney Animation Studios, and Lucasfilm.