Posted and filed under FWA, Medical Record Auditing.

If you were an attendee at last month’s webinar on arbitration and litigation support for medical coders and auditors, you’re aware of the fact that legal support is a growing need in the healthcare industry. It may come as no surprise given the alarming numbers associated with Medicare fraud in the United States, that more and more medical coders and auditors are being enlisted to help attorneys in a court of law. The extensive knowledge and experience of medical coders is being utilized quite heavily to deliver reports and subject matter expert (SME) testimony. By working alongside a legal representative, medical coders are able to present the judge and jury with expert testimony that could help crack the case.

Using our experience in the litigation support and services field, we’ve put together best practices for medical coders hoping to put their knowledge to good use.

Best Practices for Taking on a Law Firm Project

  • Clarify your role in the case. Will you be providing medical record review, serving as a SME and delivering testimony, or both? It is important to have your role defined from the beginning of the case through the end.
  • Take time to review and understand the medical case when working with a law firm. Grasping the full weight of the case will assure your success.
  • When working with a law firm on medical reviews, remember that you are creating a document that the attorneys will be utilizing and referencing during the trial. For this reason, be mindful of quality.
  • Communication is key. You will be closely collaborating with a law firm on every medical review case, and having an open dialogue will serve all involved parties well. The attorney will be using your reports in the trial, so it is important to establish a rapport and cultivate collective understanding.

Best Practices for Report Writing

  • Provide a Report Outline that clearly and simply summarizes the information that should/will be included in the official report.
  • Keep the format clear and simple. Ask the attorney if there is a template they generally follow, or if they have any formatting specifications. This will help you save time on revisions, and allow you to focus on delivering factual, succinct content throughout the process.
  • A thorough report includes the following sections: Provider Information or Background, Review/Audit Plan, Audit Detail Summary, Supporting Documentation, Recommendations.
  • When reviewing, your report ask yourself questions, “Is my report consistent from beginning to end? Does it tell a story in chronological order? Can I support any declarations made in a court of law?” If yes – your report is on the right track. If no, you may need to revise your report.
  • Quality is a MUST. Always have someone else read your report to ensure there are no fundamental (grammar, structure) or factual errors.

Best Practices for Testifying

  • Preparation is essential! Upon your review of every relevant case, make sure you fully comprehend the case that you will be testifying on and/or supporting. As a Subject Matter Expert, it is your responsibility to know the ins and outs of every case. That includes essential details, no matter how small or granular they may appear.
  • Only answer the question you are being asked. There is no need to respond with additional, irrelevant information. In fact, providing additional information may have a negative effect on the case depending upon what is reported.
  • If you don’t understand the questions, don’t be afraid to request clarification or additional information. All parties involved should be fully informed before speaking.
  • If you are asked a question that you are not qualified to answer – DO NOT attempt to answer. Kindly state that you are not qualified to answer the question at hand. This can only elevate your reputation and speak towards your integrity.
  • Take your time. There is no rush. Be sure to answer the question precisely and thoroughly. Your fellow case workers will appreciate it.

If you have any questions on or are in need of Litigation Support Services, contact us.