Medical Bill Review

MCMC provides Medical Bill Review in various markets:

  • Workers’ Compensation
  • Auto-No Fault
  • Other markets including FELA and Texas Nonsubscriber

MCMC’s Medical Bill Review program generates both savings and efficiencies for clients.  Savings result from reductions on medical bills through the application of the appropriate fee schedule / UCR and utilization review audits and edits completed by MCMC Nurse Auditors and Certified Coders.  MCMC’s experienced subject matter experts have firsthand knowledge of provider billing practices and techniques.  Our knowledge, combined with our processes, innovative technology, robust databases, and unique analysis methodologies enable our Nurse Auditors and Certified Coders to apply rules that prevent overpayment of inappropriate medical charges.  In addition, if applicable, MCMC applies reductions through a comprehensive PPO network.  MCMC also has an Out-of-Network Negotiation program that results in signed agreements and elimination of balance billing issues.  Each client can customize a program to meet their needs by using all or our programs or using an individual program to meet an individual need.

MCMC eliminates billing abuse by ensuring that each bill goes through the appropriate review process.  MCMC offers:

  • Fee Schedule / UCR Application
  • MCMC experienced subject matter experts review bills to ensure that Fee Schedule / UCR were applied properly.

Reviews may include and apply:

  • NCCI & MUE Edits
  • Multiple Surgery Guidelines
  • Physical Therapy Caps
  • Assistant Surgeon Guidelines
  • Follow-Up Days Guidelines
  • Official Disability Guideline UR Advisor Edits

Nurse Audit Review

MCMC experts apply a Nurse Audit Review on all complex provider claims.  A nurse reviews all coding and associated documentation, verifies that billing was submitted correctly and that the supplied documentation supports the individual billing codes.

Clients can customize which claims require review, typically claims designated for Nurse Audit review include:

  • Inpatient hospital
  • Trauma
  • Ambulatory Surgery Center
  • Multiple Surgical Procedures
  • EMG Testing
  • Anesthesia Codes Billed with CPT Codes
  • Unlisted Codes
  • Physical Therapy
  • Chiropractic
  • ICD9/ICD10 & CPT Codes