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CHAFA Overview /
Medical Coding Expert Witness Services
Your Trusted Partner in Healthcare Advocacy
- A Medical Coding Expert Witness is a professional in the field of medical coding who provides expertise and opinion in legal proceedings as part of a case.
- This function includes providing testimony and analyzing medical coding procedures, medical records, and related topics. Medical coding, which involves allocating standardized codes to diagnoses, treatments, and services for insurance and billing purposes, is a crucial component of the healthcare sector.
- Candidates for medical coding expert witness usually have years of experience in medical billing, healthcare administration, medical record review, and compliance with healthcare laws.
- They can additionally hold certifications as a Certified Professional Coder (CPC), Certified Coding Specialist – Physician-based (CCS-P), or Certified Professional Medical Auditor (CPMA). Expert witnesses in medical coding frequently hold advanced degrees (Ph.D. or MBA). They are connected to associations in the health information field, such as the Medical Association of Billers (MAB), the Healthcare Billing & Management Association (HBMA), the American Academy of Professional Coders (AAPC), or the American Health Information Management Association (AHIMA).
What types of cases require a medical coding expert witness?
- Expert witnesses in medical coding are frequently asked to testify in various court situations where problems with healthcare billing, documentation, and code are major points of contention. Medical fraud and malpractice lawsuits are among the top litigation matters that call for a medical coding witness.
- A vital component of medical billing is medical coding. Medical terminology, anatomy and physiology, clinical procedures, illnesses, injuries, health data standards, legal and ethical considerations surrounding health information, and classification conventions are all necessary knowledge for a medical coder to possess.
Examples of Medical Coding Expert Witness Cases
The following are some typical case types where a medical coding expert witness is likely to be needed:
- CPT codes (Current Procedural Terminology)
- Billing Disputes
- Medicare Fraud
- UCR (Usual, Customary, and Resonable) medical service fees
- Neurology medical records
- International Classification of Diseases
- Health insurance reimbursement procedures
- Clinical Documentation Auditing
- Medical Malpractice
- Healthcare compliance (HIPAA) issues
- EHR (Electronic health records) breach
What litigation support work is a medical coding expert witness expected to perform
- An expert witness in medical coding can be called upon to carry out a variety of litigation support duties to help lawyers comprehend and articulate the intricacies of medical coding within the framework of a court case.
- A medical coding specialist can offer expert witness services such as deposition testimony, expert views, research and report writing, documentation analysis, and courtroom testimony. Furthermore, a legal practice can choose to hire a coding expert as a pre-litigation adviser. A medical coding or billing expert with prior expert testimony experience may be requested by the lead counsel in a high-profile case or litigation with a sizable financial interest.
- These litigation support initiatives aim to help attorneys in developing a compelling and well-informed case by utilizing the knowledge of medical coding expert witnesses. When medical coding nuances are essential to comprehending the events under investigation, this guidance is invaluable.
- With the ideal combination of experience and skill in testifying, CHAFA Helps can expedite the process of finding a medical coding expert witness. We have a well-deserved reputation for sending experts with the ideal mix of experience and knowledge to support each case, whether acting as a plaintiff or defendant.
