BILLING EXPERT

Dr. Morris explains that the Current Procedural Terminology (CPT) coding system was designed to provide a uniform data set that could be used to describe medical, surgical, and diagnostic services rendered to patients to determine reimbursement to a provider or medical facility. CPT codes — which consist of five alphanumeric digits — are published by the American Medical Association and there are approximately 10,000 of them currently in use.

Part of Dr. Morris’ work with ARM involves his role as a medical billing expert witness providing unbiased testimony in a court of law, helping a jury to understand the complicated economic healthcare marketplace. In this role, Dr. Morris draws on far more than his extensive knowledge of the CPT coding system — in fact, CPT code assignment is only the foundation of his expertise.

“The end goal is to unbiasedly determine the reasonable value of medical services rendered,” says Dr. Morris. “In order to do that, you must provide a past medical billing audit analysis correlated with the patient’s medical records, which ensures that the providers have used the appropriate standards when billing for their services.” To accomplish this Dr. Morris uses a methodology called usual, customary, and reasonable (UCR) which is a widely accepted method of generating healthcare prices. “This methodology compares a provider’s charge to similarly situated providers performing similar services in the same community by zip code,” says Dr. Morris.

Reasonable value is defined as a price that a willing owner would sell and a willing purchaser would buy, but neither being under any obligation to do so.

“The final step in determining reasonable value is to place these audit findings into the context of the particular healthcare market that the medical services were rendered in,” says Dr. Morris. “Once all of these steps are completed, I can present my expert testimony as to the value of the medical services in question.”

Andrew S. Morris, DC, is a medical billing expert, businessman, and Chiropractor licensed in California. Dr. Morris has practiced chiropractic for 23 years while also working on the administrative side of medicine, creating policies and procedures for medical billing and coding.

Backed by his extensive medical, administrative, and billing knowledge, Dr. Morris founded Acclaim Recovery Management (ARM) — a medical billing, coding, and recovery company — in 2014.

Medical billing and medical coding are two distinct but interconnected parts of the healthcare system. Medical coding, which is typically the first part of the billing process, involves applying particular codes to particular treatments and medical billing involves submitting claims to insurance companies for payment which outline the assignment of these codes, providing legitimacy to the claim.

Dr. Morris testifies in cases involving treatments and procedures for many types of injuries — the shortlist includes orthopedic extremity and spine, burns, fractures, and lacerations — but there is one diagnosis that poses more of a challenge in the courtroom than most others; traumatic brain injury (TBI).

Medical coding for a TBI can be complex due to the multiple treatments a patient may undergo. “Addressing the symptoms of a TBI requires a multidimensional approach,” says Dr. Morris. “A person may need neurosurgical intervention, participate in outpatient neurocognitive rehabilitation, receive occipital nerve stimulation, or any number of other treatments prescribed for TBI, making treatment plan analysis complicated because each intervention can be coded in multiple ways.” ARM works on many TBI cases employing an abundance of experience to code them effectively.

For more information about Acclaim Recovery Management visit them online at acclaimrm.com.