Medical Billing Expert Services

MBE is a specialized medical billing review firm working with attorneys and their clients, whether they are plaintiffs or defendants, to ensure that medical bills are justified. Our billing review experts identify inconsistencies, errors and inflated bills and can help to save thousands of dollars on payment for medical treatment.

The following services are provided by MBE:

Medical Billing Review

Medical billing review is an important service for anyone who has been presented with a medical bill of any type. Medical bills are frequently higher than justified by the services provided. There are many reasons for this and often these are hidden in the complexity of the bill. It is unreasonable to expect those who are untrained in medical billing and coding procedures to know whether a particular bill is higher than it should be and yet savings from a billing review can run into the thousands of dollars. In fact, medical bills are routinely paid by individual patients and third party payers such as Medicare and Medicaid that are overinflated.

The solution is in a medical billing review before the bill for medical services is accepted. MBE’s billing reviewers carefully examine every detail of a medical bill, looking for inconsistencies and errors that might cause an over inflated figure. Billing reviewers have an excellent working knowledge of medical coding, an essential and basic requirement for verifying the accuracy of medical bills. An incorrect match between medical codes specified on medical providers’ bills is a common error which would be impossible to notice if the bill was examined by anyone without this depth of knowledge. Basically, what the reviewer is looking for is a fee which matches the correct diagnosis, procedures and treatment which have been provided by the physician or other medical providers for the client.

MBE’s billing review experts typically work in close association with attorneys representing clients who are personal injury, medical malpractice or workers’ compensation claimants. Billing review however may also be provided by agencies such as Medicare, Medicaid and other third party payers, as well as insurers representing clients who are defendants in a personal injury or medical malpractice lawsuit or employers for a workers’ compensation claim.

Medical Coding Review

Medical coding may seem like a strange and unnecessary language by those who are not acquainted with it, but in fact it is an intrinsic art of medical billing. It converts often highly cumbersome medical reports into an efficient reporting system consisting of unique codes that represent diagnoses, procedures and treatment.

Medical coding review is an important job provided by MBE’s billing review experts as it involves examining the codes on a medical bill and comparing them with what is known about the individual’s medical situation.

The three main types of codes that are used in medical coding are CPT codes, ICD codes and HCPCS codes. There are also billing codes used by both physicians and other medical providers.

CPT codes are a comprehensive list of codes that describe what has been done for a particular patient. They may include all types of medical procedure, such as X-rays and scans and surgery, just to mention the most common. Each code identifies a particular medical procedure.

HCPCS codes are similar in many ways to CPT codes and some are identical. The main difference is that HCPCS codes are used whenever agencies like Medicare, Medicare or other third party payers are involved.

ICD codes are the codes used to identify the many hundreds of possible diagnoses made of the condition in which a particular patient is found in.

Whenever a medical report or bill is presented, it will contain the relevant codes which define what the patient was or still is suffering from and what has been done to treat the problem. Our MBE reviewers examine these codes in minute detail. One of the reasons why some bills are too high is because the wrong code has been used, either because the procedure(s) used do not match the diagnosis or because the procedure(s) were medically incorrect for what is known about the individual’s medical history.

Medical Cost Projection

Medical cost projection (MCP) is a necessary and difficult task whenever an individual’s medical needs are likely to be extended into the future. It is a form of analysis which provides a set of recommendations based on evidence so that the medical portion of a larger than usual claim can be managed positively. Often for these recommendations to be made, complex medical and legal information must be analyzed beforehand.

Any future recommendations, inevitably, have an element of speculation about them, but an educated speculation is better than an uneducated one. The emphasis is on providing an improved quality of life for the individual at the same time as maximum financial savings for the payers. MBE’s reviewers are able to make use of highly knowledgeable legal nurses who have built up a wealth of experience in identifying cost projections in a wide variety of differing medical cases.

Life Care Plan

Life care planning is required whenever catastrophic injuries and disabilities have prevented an individual from continuing their normal life as it was before a workplace or other injury. Life Care Planning agencies exist which develop concise and organized plans for the resent and projected future needs as well as the cost of those needs for any individual who has experienced a severe injury or has developed a chronic health care problem.

MBE’s certified life care planners will assist you with every phase of the case – from developing the initial assessment and report to helping you prepare for the opposing life care planner’s deposition and to testify at deposition and trial. Life care plan is a tool to determine the monetary value of future medical and disability related needs.

MBE’s experienced life care planners can provide an organized, concise plan for current and future needs of individuals, who have experienced catastrophic injury or has chronic health care needs.  Definition from “Life Care Planning and Case Management Handbook”, Roger O. Weed, Ph.D. (Ed), CRC Press 1998

Medicare-Set-Aside

A Medicare Set-Aside is a trust set up to administer payments that have been received as part of a workers’ compensation settlement so that this money can be used in the future rather than money from Medicare. This only applies to those already on Medicare when the claim is processed (those over 65 and others who have been receiving disability benefits through SSDI), or when a recipient of a claim payment is soon to go onto Medicare.

Medicare is only a secondary payer, so that any settlement payments that have been paid are expected to be used up first before Medicare picks up the bill.

In personal injury cases, Medicare may have already paid for medical expenses that were necessary before any claim was filed. The at-fault party is judged the primary payer, so any Medicare payments that have already been used for these specific injuries will need to be paid back to Medicare. In the future, it may be necessary for personal injury claimants to have a Medicare Set-Aside trust for any future medical expenses in the same way as workers’ comp. claimants.

MBE’s billing review experts will thoroughly check all medical bill payments before they are put into a Medicare Set-Aside trust to ensure that they are an accurate representation of what has been actually provided or anticipated.

Worker’s Compensation Billing Review

A workers’ compensation billing review can be ordered whenever a bill for medical treatment is submitted as part of a workers’ compensation claim. In this case, most requests to MBE for a workers’ comp/billing review will either be from the employer or the employer’s insurer who will be expected to make a payment to compensate a particular employee’s claim related to a valid workplace injury or illness.

MBE’s billing reviewers examine the bills provided in the context of state workers’ compensation scheduled fees. In many cases, medical providers will often bill the insurer or payer based on what is ‘customary or usual.’ However, this may or may not match state regulated fees schedules. Insurers and other payers can often save themselves large sums of money which can be reimbursed by using a workers’ compensation billing service.

Additional Services

MBE’s well-qualified and experienced billing reviewers may be able to help you understand, dissect and save money on medical bills that you do not fully understand. Whatever the nature of your concern, give MBE a ring or complete a ‘Contact Us’ form with your query and one of our experts will respond promptly.