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Medical Billing Expert Witnesses and Texas Law
Physician and facility charges can be diverse. A medical billing expert, like those at Veritas Experts, is qualified to audit medical charges and testify to what constitutes fair and reasonable billing practices, per §18.001(f) as set forth by the Texas Supreme Court in Alaniz v Allstate.
Our team has the in-depth knowledge, experience, and access to determine what constitutes fair pricing in medical billing.
Contact us for report details, pricing, and timelines.
Veritas Experts follows the American Medical Association (AMA) policy for Usual, Customary, and Reasonable (UCR) in analyzing medical charges.
AMA Policy H-385.923 uses the following definitions:
(a) “usual; fee means that fee usually charged, for a given service, by an individual physician to his private patient (i.e., his own usual fee);
(b) a fee is ‘customary’ when it is within the range of usual fees currently charged by physicians of similar training and experience, for the same service within the same specific and limited geographical area; and
(c) a fee is ‘reasonable’ when it meets the above two criteria and is justifiable, considering the special circumstances of the particular case in question, without regard to payments that have been discounted under governmental or private plans.
AMA takes the position that there is no relationship between the Medicare fee schedule and Usual, Customary and Reasonable Fees.
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