Medical Bill Analysis

RPC has over 20 years of experience reviewing medical bills. RPC staff can provide a comprehensive analysis of medical bills in personal injury litigation and in fee disputes between providers and health plans. We assist plaintiffs and defendants, providers and health plans. We have assisted state agencies in designing medical fee guidelines. We can provide analysis and expert opinions on:

• Correct coding of services
• Medical necessity and relatedness
• Reasonableness of charges, rates and value of services
• Correct calculation of negotiated and regulated rates
• Penalties and interest for failure to make prompt payment
• Identification of false claims in qui tam litigation
• Texas Section 18.001 counter affidavits
• Future medical costs in life care plans and medical cost estimates
• Calculation of allowable amounts under Medicare, Texas Medicaid, and Texas Worker’s Compensation
• Chargemaster Analysis

RPC has a multi-disciplinary staff to conduct the required analysis on a few claims or thousands of claims. This staff includes physicians, nurses, certified coders, forensic accountants, economists, statisticians, and IT professionals. We have the IT capability to organize claims and payment data in ANSI and process it using SQL, STATA and other software.

RPC works closely with plaintiff and defense attorneys to fashion effective discovery requests and deposition questions to obtain the data and needed medical claims and payment data in a form we can analyze efficiently to reach defensible opinions on the relevant questions. You can download the amicus brief RPC filed with the Texas Supreme Court (In Re North Cypress Medical Center Operating Co., Ltd.) supporting expanded discovery to determine the reasonable value of services by out-of-network providers. RPC staff have been accepted as experts in state and federal courts in multiple states.

From our web site you can download RPC white papers that explain how we determine usual, customary, and reasonable (“UCR”) charges and the sources and methods we use to estimate medical costs for life care plans and other studies. You can also contact us at any time for a no obligation document review and discussion of your case.