When the medical numbers matter, the methodology behind them matters too.
Medical bills, insurance reimbursement, coding, UCR data, and future care recommendations can quickly become some of the most technical components of a case. CodeWise Solutions provides independent medical coding and cost analysis for both Plaintiff and Defense matters, translating complex healthcare reimbursement information into clear, supportable conclusions.
Our analyses are based on the needs of the individual case and may incorporate actual negotiated commercial insurance rates, Medicare, Medicaid, Workers' Compensation, UCR data, patient cost-sharing, and other applicable reimbursement methodologies
Past Cost of Care Analysis
What was billed and what would reasonably be reimbursed are not necessarily the same number.
A Past Cost of Care Analysis evaluates medical bills and supporting records to determine applicable reimbursement for services already rendered. Depending upon the assignment, the analysis may include
- commercial insurance reimbursement
- Medicare
- Medicaid
- Workers' Compensation
- patient out-of-pocket responsibility
- other applicable methodologies.
Optional UCR analysis can also evaluate billed charges within the applicable geographic market
Future Cost of Care Analysis
When a Life Care Plan identifies future medical needs, CodeWise Solutions provides the coding and reimbursement analysis behind those recommendations.
Future Cost of Care Analyses evaluate recommended services using applicable coding and reimbursement methodologies, which may include:
- commercial insurance market rates
- Medicare
- Medicaid
- UCR data
- anticipated patient cost-sharing
This service can also include review of the coding and costing presented by another expert when requested.
Medical Cost Projections
Not every case requires a full Life Care Plan.
A Medical Cost Projection is a records-based estimate of anticipated future medical care and associated costs, typically developed from recent medical records for use in mediation and settlement negotiations. Unlike a Future Cost of Care Analysis, the projection identifies anticipated services as well as their associated costs.
Because this service is intended for settlement purposes, a Life Care Plan from an appropriate clinical provider should be obtained if the matter proceeds to trial
Need something else?
UCR analysis, expert report rebuttal, deposition/testimony support, and customized assignments may be added to an engagement based upon the needs of the case.