Medical Coding and Billing Experts

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.