Juris Medicus is a national leading medical expert and legal services firm. On May 7, 2021, the Texas Supreme Court delivered a highly-anticipated ruling regarding the firm’s billing and coding experts. The opinion marks a significant victory for Juris Medicus. The firm succeeded in blocking the growing trend of challenges to billing and coding experts who refute medical expense affidavits.
The Texas Supreme Court ruling is entitled In Re Allstate. It has provided some much-needed clarification on Section 18.001 of the Texas Civil Practices and Remedies Code.
What is Section 18.001 of the Texas Civil Practice and Remedies Code?
Section 18.001 is a statue that allows an injured party to offer up medical bills by having a caregiver or guardian sign an affidavit to say they were reasonable and necessary. If a legal team wishes to challenge the reasonableness and necessity of the affidavit, it has to file a counter-affidavit.
The counter-affidavit must come from a qualified expert within a certain time period. Any failure to file a counter-affidavit is considered the waiving of the right to raise a challenge to the reasonableness and necessity of the care.
What are the details of the Texas Supreme Court ruling?
Firstly, non-medical professionals, such as billing and coding experts, may be qualified to testify about the reasonableness of medical expenses. The “reasonable notice” requirement is satisfied where the counter-affidavit identifies the disputed charges and compares them to median charges from databases.
As well, Section 18.001 does not require counter-affidavits to satisfy the standards for admissibility under Rule 702 or Robinson. As a result, challenges to relevance and reliability are not proper grounds to strike a counter-affidavit. Finally, there is no exclusionary sanction for failure to comply with Section 18.001. The failure to serve a compliant counter-affidavit has no impact on party’s ability to present evidence and to challenge reasonableness or necessity at trial.
Juris Medicus has long been advocating for the Texas Supreme Court ruling.
Many of Juris Medicus’ clients have reported having their pending motions to strike withdrawn and their hearings dropped after the ruling was made. It is expected that the decision will continue to have a widespread impact on the ability of anyone to challenge the firm’s billing and coding experts.
At Allegiant Experts, we encourage the provision of quality healthcare services.
Everything we do focuses on inclusive, comprehensive and cost-effective healthcare. Our team coordinates and supports courageous whistleblowers who shine lights on fraud, waste and abuse. We also consult with and educate attorneys who fight against wrongful billing practices that negatively impact both individuals and the larger health care industry.
In addition, we mentor healthcare delivery agencies that just want to get their billing right. We identify facts, find the errors and illuminate the truth at issue. We do all of this by keeping our clients informed at every step in the process. Our team always provides its very best and most qualified opinion as we constantly strive to meet the needs of our clients.
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