Medical Coding Expert Witnesses
What is a medical coding expert witness?
Medical coding expert witness candidates typically have years of experience in healthcare administration, medical billing, medical record review, healthcare compliance, and/or are a Certified Professional Medical Auditor (CPMA), Certified Coding Specialist – Physician-based (CCS-P), or Certified Professional Coder (CPC). Oftentimes medical coding expert witnesses have a higher education degree (MBA or PhD) and associated with a health information industry organization such as the American Academy of Professional Coders (AAPC), the American Health Information Management Association (AHIMA), the Healthcare Billing & Management Association (HBMA), or the Medical Association of Billers (MAB).
What types of cases require a medical coding expert witness?
Medical coding is an important component of medical billing. It involves an analysis of statements by a physician or other health care provider, and the assignment of standard codes using a classification system. A medical coder needs to understand medical terminology, anatomy and physiology, clinical procedures, diseases, injuries, the legal and ethical aspects of health information, health data standards, as well as the classification conventions.
Medical coding expert witness case examples
Example cases that Cahn Litigation Services has searched for medical billing expert witnesses have encompassed:
- Current Procedural Terminology (CPT codes),
- Medicare fraud,
- Medicaid medical bill reimbursement,
- neurology medical records,
- life care plan payers,
- Usual, Customary, and Reasonable (UCR) medical service fees,
- International Classification of Diseases (e.g., ICD-9, ICD-10-CM),
- health insurance companies reimbursement procedures,
- medical cost and medical necessity assessment as a result of a personal injury,
- clinical documentation auditing in Florida,
- Medicare and Medicaid fee schedule and medical bill reviews,
- HIPAA matters,
- Medicare Set-Aside law,
- electronic health records (EHR) breach,
- independent medical examination (IME) methodology, and
- legal nurse testimony in a medical malpractice suit.
What litigation support work might a medical coding expert witness be expected to perform?
Expert witness services by a medical coding specialist could include documentation analyses, research and authoring expert reports, providing expert opinions, deposition testimony, and courtroom testimony. In addition, a law firm may seek a coding specialist for pre-litigation consultant work. In a high-profile case, or litigation involving a significant financial stake, the lead attorney may request a medical coding or medical billing expert with prior expert testimony experience.
Cahn Litigation Services has the experience required to turn a search for a medical coding expert witness around quickly, providing the right balance of expertise and testimony experience. On behalf of a plaintiff or defendant, the firm has an earned reputation for providing experts with the right balance of expertise and testimony experience to support each unique project.
Medical Coding Expert Witness - Representative Bios
Please Note: All Cahn Litigation expert witness searches are customized to attorneys' precise specifications and preferences. Attorneys are encouraged to discuss search parameters with a Cahn search specialist.
The below expert witness bios represent a small fraction of those Medical Coding experts known by Cahn Litigation Services. These bios are provided to give lawyers a sense of the Medical Coding landscape.