MEDICAL CLAIMS AND CODING

Medical claims and coding is really a process that is included in many other products and review types. We cannot overemphasize the importance of correct coding that is dependent upon review of the actual medical records, as opposed to automated coding edit systems. Our distinct value added is the application of physician specialist knowledge to review operative reports and medical records. Coding decisions are influenced by, but not exclusively determined by, Medicare and other large insurer guidelines. While we realized the importance of provider networks, we also understand the use of only coding edit systems, may leave significant savings on the table, without actual medical records review. High volume claims warehousing and processing operations overlook specific savings that are achieved by the application of human intelligence to the actual medical record.