Medical Billing and Coding expert witness must possess a thorough understanding of several factors and be comfortable providing oral and written testimony for depositions, expert reports and trial appearances in court. Establishing a baseline for usual customary and reasonable (UCR) costs for care starts with an evaluation of the clinical documentation and coding.  An expert witness may use 

Michael Arrigo medical coding and billing expert witness, Usual Customary and Reasonable cost of care
Michael Arrigo medical coding and billing expert witness, speaker and published author. Usual Customary and Reasonable cost of care  Contact here
this type of analysis may be required in personal injury cases, class actions, workers compensation, fraud and false claims act litigation, life care plans in medical malpractice, or other engagements. Several factors may be considered including:

  1. Inpatient procedures under the Inpatient Prospective Payment System (IPPS) for medical billing and medical coding expert witness
  2. Outpatient procedure under the Outpatient Prospective Payment System (OPPS) for medical billing expert witness and medical coding expert witness
  3. CPT codes (Current Procedural Terminology (c) American Medical Association for outpatient procedure expert witness
  4. CPT codes for physician coding expert witness and physician billing expert witness
  5. ICD-9 codes for diagnosis medical coding expert witness and inpatient procedure billing expert witness
  6. ICD-10 CM codes for diagnosis coding expert witness and ICD-10 PCS inpatient procedures
  7. DRG (diagnosis related groupings) used in the Inpatient Prospective Payment System (IPPS)
  8. Hierarchical condition codes (HCCs) used in risk adjustment for Medicare Advantage (Medicare Part C) or Accountable Care Organizations (ACOs)
  9. Relative value units (RVUs) in diagnostic imaging or the Outpatient Prospective Payment System (OPPS)
  10. Geographic analysis based on Geographic Adjustment Factors and wage Indeces
  11. Medical necessity as listed in Medicare National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs)
  12. Prior authorizations
  13. Guidance from Medicare Administrative contractors (MACs)

A competent expert witness must be capable of using state and federal statutes, guidelines and industry best practices in these areas to support their opinions.