Medical Billing Expert Witnesses in Texas

Medical billing expert witnesses are a valuable resource in personal injury lawsuits, as they can provide crucial testimony about the Usual, Customary, and Reasonable (UCR) charges associated with medical costs, per §18.001(f), as determined by the Texas Supreme Court in Alaniz v Allstate.

These experts are typically medical billers or auditors who have extensive experience analyzing medical records and bills to identify if discrepancies exist between what was charged and what is considered reasonable according to standard industry practices.

The ability of medical billing specialists to testify on what constitutes UCR in health care makes them a critical asset for attorneys representing plaintiffs or defendants in these cases.

For plaintiffs, medical billing experts can determine if medical bills prove that the costs were reasonable and fall in line with industry standards. For defendants, their knowledge of current procedural terminology (CPT) codes and pricing can demonstrate if medical costs were unreasonably high or inflated by the provider.

No matter which side of the lawsuit your client may be on, medical coding and billing expert testimony can provide verifiable charge accuracy and help ensure justice is served.

Medical billing specialists are well-versed in the regional variations in costs within the healthcare industry. This enables them to understand the unique considerations that influence the reasonableness of charges, such as differences in local health plans and reimbursement rates.

As a result, medical billing expert witnesses are an essential resource for anyone involved in cost disputes. They provide critical information on how these regional differences impact physician and hospital charges and their viability in legal proceedings.

Medical billing experts are impartial third parties able to give accurate and unbiased testimony in litigation. As independent billing experts and not medical professionals, they offer a trustworthy evaluation of charges, independent of healthcare providers.

Relying on a physician as an expert witness to verify their own charges as reasonable does not provide this impartiality. Similarly, a financial expert does not understand the many details involved in medical procedures and their associated costs.

A Medical Billing Expert can:

• • Review the medical records for reasonableness and appropriateness of the treatment rendered
  • Research and determine the prevailing charges in the geographic area for each medical necessity
  • Compare the medical charges in the records to those of similar providers in the same region
  • Assist in developing a report for filing an initial affidavit or counter affidavit with supporting analysis
  • Provide Expert Witness Testimony

The expert’s report will provide an unbiased overview of the medical treatment received and an analysis of the reasonableness of the charges. In some instances, the charges may be higher than what is customary for the region. The expert can also identify any potential errors or inaccuracies in the records, which could impact the outcome of your case.

If you are an attorney seeking litigation support from a medical billing expert witness or an impartial medical bill review, be sure to work with someone that has experience working with law firms on personal injury cases. With the right expertise in evaluating billing records and related documentation, they will provide insight into the charges that were incurred as well as any coding or regulatory issues that may affect your client’s settlement.

To find out more about working with a medical billing expert in Texas, contact Veritas Experts today.