ICD-9, HCPC and CPT Code Review

• We review bills to ensure correct usage of industry standard coding of diagnoses codes and various standard procedure code sets.
• Our process supports the American Medical Association's guidelines for billing and coding.

Reasonable and Customary Rates

• We use a national database comprised of provider charges for each geographical area within the US to evaluate the charges for a particularly provider.
• Evaluation of each DME claim including reimbursement recommendations for custom-fitted orthosis and prosthetics.
• DME pricing for both rental purchase and rent-to-purchase agreements.

State Specific Fee Schedules in NY, PA, HI, UT, and NJ

• In these states, specific fee schedules have been adopted by the various legislatures for the pricing of auto claims. We support all specialty tables.

Review of Bundled and Inclusive Services

• We review each bill to ensure that providers are adhering to standard billing practices in regards to services that should be combined into a single code or billing an extra code for a service included in another.

Evaluation of Hard and Soft Duplicate Bills

• Hard Duplicates are bills where the same claimant, same date of service, same service, and same provider are billed a second time.
• Soft Duplicates are bills where some of the information contained may match bills already priced, but that are not 100% the same.
• Our staff investigates all soft duplicate bills to determine duplicate status and recommend payment where appropriate.

Pharmacological Evaluation

• AWP pricing service available.