Medical Billing Expert
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 administrativeside of medicine, creating policies and procedures for medical
billing and coding.
Backed by his extensive medical, administrative, andbilling knowledge, Dr. Morris founded Acclaim Recovery Management (ARM) — a medical billing, coding, and recoverycompany — 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 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.”