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Why You Need Medical Billing Analysts

Engaging a medical billing and reimbursement expert to determine and testify to the reasonable value of medical services, based on the provider’s location, is highly recommended.

Whether you are on the plaintiff or defense side, determining the cost of medical care can be complicated and the guidance of an expert is critical to ensure you have a clear understanding of what is “fair and reasonable.”

MBA provides litigation support services nationwide with offices in NY, NJ, CT, PA, GA, FL, TX, NV & CA. It represents both defendants and plaintiffs in matters pertaining to improper medical coding and/or billing. MBA’s coding/auditing consultants have extensive experience evaluating the accuracy of ICD-9-CM/ICD-10-CM, CPT® (including E/M coding), HCPCS, and modifier use. They are well acquainted with coding rules and conventions as well as guidelines regarding the proper use of specific nomenclatures and reimbursement methodologies.

Knowledge of ICD-9-CM/ICD-10-CM coding rules and conventions, as well as published guidelines, is the most critical factor in determining the accuracy of medical bills and whether or not the billed charges are fair and reasonable according to the UCR fee schedule.

MBA can provide an evaluation of a single medical charge from a single medical provider to testifying in court regarding the charges from a number of medical providers and suppliers in very complex cases.

With Medical Billing Analysts on your legal team, your staff stays focused on your case while we support you during the research and discovery phases. We will analyze all medical bills and help you determine what the fair and reasonable cost of medical care is. Our services can help expedite your PI claims.

Call us to ask us about our discounted rate, if bundled with a service from our parent company, Occupational Assessment Services.

Court Cases

State Farm Insurance Co v Bowling.

The Second District Court ruled medical billing and coding experts can testify as to fabricated or exaggerated medical expenses. The court found coding experts have “specialized knowledge” and training to provide opinions on whether bills are properly coded, and whether they correspond to medical records that documented the purported treatment.

Howell v Hamilton Meats and Provisions,

In California, it was ruled that an injured plaintiff whose medical expenses are paid through private insurance could only recover the contractually adjusted amount which was actually paid, not the full amount billed.

Hahnemann Hospital v Sonya Dudnick

In NJ, a hospital brought an action against a former patient to recover the balance due on a bill for medical services. In the hospital’s collection action, the former patient failed to establish that charges reflected in the bill were not usual, customary, and reasonable and the court ruled against Defendant. The plaintiff's attorney brought to trial the hospital custodian of records who testified as to the reasonableness of the medical bill. The court ruled that the Plaintiff’s foundation witness, as the custodian of records with knowledge of the billing procedures, was qualified to testify as to the charges incurred by the defendant as contained in the hospital’s bill.