AAPC specializes in healthcare reimbursement. We know the regulations and guidelines governing medical billing and coding. We also know the cost of error, which can exceed tens of millions of dollars. As the leading credentialing organization of healthcare information management professionals, we set the standards for expertise. Should you need that expertise in relation to litigation of alleged improper billing and coding, we can ensure you receive accurate and trustworthy litigation support.
AAPC Services offers investigative medical auditing, consultation, and expert witnesses for deposition testimony and court testimony. We work with legal teams on behalf of plaintiffs, defendants, patients, providers, payers, and government agencies. Our experts have provided litigation support in criminal and civil cases and in state and federal courts.
Expert Witness
As medical auditors, they have consistently demonstrated accuracy assessing allegations.
With tenures in the classroom and bylines in industry publications, they have proven adept at breaking down coding nomenclature and simplifying the complexities of coding and billing regulations, code set guidelines, and payer guidelines.
As subject matter experts, they have reliably delivered compelling witness testimonies in depositions and in open court, remaining clear-headed and articulate amid adversarial cross-examination.
With extended experience across multiple places of service, our medical billing experts possess master-level proficiency in ICD-10-CM and -PCS, CPT®, and HCPCS Level II — as well as the methodologies that link these code sets to APCs, MS-DRGs, and MS-LTC-DRGs. Their medical specialty experience is equally diverse, ranging from pediatrics and behavioral health to anesthesiology and level 2 trauma. Cases in which they’ve provided litigation support include:
Medical necessity (based on chart review)
Healthcare fraud
Qui tam actions
Overbilling and concealment
Payer/provider disputes
In meeting trial evidentiary standards, our expert witnesses have been qualified through knowledge, skill, practical experience, training, and education. Below is a partial list of credentials held by our three litigation support experts.
CPC — Certified Professional Coder
CPC-I — Certified Professional Coder, Instructor
CIC — Certified Inpatient Coder
CCS — Certified Coding Specialist
CCS-P — Certified Coding Specialist, Physician
CICA — Inpatient Coding Auditor, HFMA
COC — Certified Outpatient Coder
Approved ICD-10-CM/PCS Trainer
CEMC — Certified Evaluation and Management Coder
CFPC — Certified Family Practice Coder
CDIP — Certified Documentation Improvement Practitioner
RCC — Radiology Coding Certification Board
CPC-H — Certified Professional Coder, Hospital
CPCO — Certified Professional Compliance Officer
CHCO — Certified Healthcare Compliance Officer, Healthcare Compliance Resources
CPAR — Certified Patient Account Representative
CRCR — Certified Revenue Cycle Representative
CPHM — Certified Professional Healthcare Management
ACS-OP — Ambulatory Care Center, Outpatient
FCS — Flexible Compensation Specialist
CPMA — Certified Professional Medical Auditor
RMC — Association of Registered Healthcare Professionals
If facing repayment request resulting from a federal contractor or payer audit, let us validate the accuracy of audit findings. We have experience responding to the Centers for Medicare and Medicaid Services reviews associated with pre- and post-payment audits, particularly with:
Quality Improvement Organization (QIO)
Recovery Audit Contractor (RAC)
Supplemental Medical Review Contractor (SMRC)
Unified Program Integrity Contractors (UPICs)
Investigations Medicare Drug Integrity Contractor (I-MEDIC)
Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC)
Our audit team often identifies errors in third-party determinations that reduce repayments. When money is owed, we can help you avoid repayments in the future by teaching your staff how to correct trends in documentation and coding.
If your provider organization is required by the Office of Inspector General (OIG) to participate in a Corporate Integrity Agreement, AAPC Services can serve as your Independent Review Organization (IRO). We work with a variety of government agencies and attorneys general throughout the U.S.