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
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
Meet Some of Our Software Experts
Anna Mathias is a certified Project Manager with a focus in organizing, supporting, and contributing to work products related to Electronic Health Record (EHR) software quality, regulatory, and patient safety assessments. She is a strong leader and team player with excellent interpersonal and communication skills.
Andrew Holm-Hansen has worked in Health IT for 15 years, and led several development teams during his career. As an Enterprise Architect, he distilled complex information that cut across legal, staffing, and technology boundaries, to provide decision-makers with actionable information.
Dr. Jae Young Bang is a Senior Computer Scientist and the Director of Software Development with over a decade of experience in software engineering. He currently serves as a testifying expert and source code reviewer in software litigation including patent/copyright infringement and breach-of-contract matters. Jae also leads software research and development efforts.
Luis Padilla provides insight from expertise in hardware design and software development. Holding a B.S. in Electrical Engineering, he has acquired knowledge in various technology domains, including firmware, embedded systems, cloud computing, and cellular protocols. Paired with strong communication skills, Luis excels at making complex technical concepts digestible for non-technical people.
Alicia Morton Farlese is a retired Captain serving twenty-six years in the United States Navy Nurse Corps, and was a senior leader in national health IT policy at the US Dept. of Health and Human Services. Dr. Farlese assists clients in meeting Health IT regulations, including Information Blocking requirements of the Cures Act.
Rick Watts’ exceptional career in information systems implementation spans 30 years. As an experienced and certified Enterprise Architect, Project Management Professional, and Software Engineering Master, his formidable expertise is well-suited for disputes involving enterprise software implementation, technical architecture and design, and systems integration delivery.