Expert Witnesses and Scientific Evidence

Expert Types

Billing and Coding Expert

Billing and Coding Expert

Billing and Coding Expert

Billing experts review itemized statements and coding against documentation, identifying unbundling, upcoding, duplicate charges, services not documented, and charges exceeding usual and customary rates.

Certification through AAPC or AHIMA is common.

Alternative Names:

Medical Billing Expert, Coding Expert

Why it Matters?

These experts address the reasonableness component of medical specials, which is separate from causation and frequently unexamined. Comparing billed codes against the clinical documentation identifies services charged but not performed, and comparing charges against regional benchmarks addresses reasonable value. In jurisdictions permitting evidence of amounts accepted as payment, the analysis extends to the gap between billed and collected.

Frequently Confused with

Frequently asked questions

What does the analysis identify?

Why is this analysis often skipped?