Expert witness for Medical Billing Coding

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Expert witness for Medical Billing Coding

Medical Billing Coding

Michael Arrigo expert witness in Federal State and Civil Courts on Fraud, Affordable Care Act, HIPAA, Healthcare costs in malpractice and personal injury, drug pricing, False Claims Act cases involving Medicare Advantage and Electronic Health Records.  Click here to contact.

Medical billing coding work requires rendering opinions on the Usual Customary and Reasonable cost of care.   I receive questions on the difference between different types of care, codes and billing and the role of various entities in health care revenue cycle management and claims management. It is important to take into account inpatient and outpatient payment rules, federal and state statutes and industry best practices and guidelines.  The privacy and security of patient records being evaluated as prescribed under the HITECH Act or HIPAA must be considered including safeguards, policies and procedures to ensure the privacy and security of protected health information (PHI).  Medical Billing Coding also requires a data driven approach.

Also, the timing of expenditures in relation to inpatient care may be important.  Diagnosis codes including ICD-9 and ICD-10 CM as well as procedure codes, ICD-9 and ICD-10 PCS as well as outpatient procedures using the AMA standard Current Procedural Terminology (CPT®) HCPcS codes may be factors.  Inpatient stays may require review of Diagnosis Related Groupings (DRGs) using the IPPS system (inpatient prospective payment system).  Outpatient Prospective Payment System (OPPS) or Ambulatory Procedure Codes (APCs) may apply in an Ambulatory Surgery Center (ASC). Additionally, payments via various payors whether private insurance, Medicare and Medicaid via the Centers for Medicare and Medicaid may be factors.  Medical codes are determined by coders who rely on physician or physician assistant diagnosis and prescribed procedures.  Additionally, diagnostic imaging, pharmaceuticals and durable medical equipment costs (DME) may be factors.

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By | 2018-03-02T08:32:21+00:00 February 9th, 2016|Drug Pricing, Expert Witness, ICD-10, Medical Billing and Coding, UCR|0 Comments

About the Author:

Michael is Managing Partner & CEO of No World Borders, a leading health care management and IT consulting firm. He leads a team that provides Cybersecurity best practices for healthcare clients, ICD-10 Consulting, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, Insurance Fraud, payor-provider disputes, and consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $4 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, Stanford Medical School - Biomedical Informatics, Harvard Law School - Bioethics.
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