A medical expert woman at computer reviews hospital billing records

Medical Coding and Billing Experts

A medical expert woman at computer reviews hospital billing records

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.

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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

Technical Skills + Healthcare Awareness

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.

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A medical professional at computer reviews hospital billing records

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

Billing Audits

  • 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

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VP of Emerging Tech Due Diligence Los Angeles

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Jae young Bang - Director of Software Development

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