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Making a Counter Affidavit Work for Your Case
Cases that have to do with medical billing can be complex. Fortunately, the legal professionals at Juris Medicus are here to help you and your clients better understand the ins and outs of counter affidavits. We are skilled in locating medical and billing/coding experts to provide you with a strong testimony and a stable basis for your court case, mediation, or arbitration. Our team specializes in Texas law and has worked with attorneys in nearly every major city, including Houston, Dallas, San Antonio, and Corpus Christi. Learn more about how to make a counter affidavit work for your client.
What Is a Counter Affidavit?
A counter affidavit is a medical or billing/coding expert's testimony that opposes what was outlined in the initial billing affidavit. This testimony, which must be both written and notarized, contends that the charges in the billing affidavit are not usual, customary, or reasonable (UCR) given the standards of the service, setting, or geographic area. A counter affidavit is not the same as a cost report. While these documents have similar content, a cost analysis report does not have to be notarized. Either a counter affidavit or a cost analysis report can be prepared for past, current, or future medical service charges.
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How a Counter Affidavit Works
To understand how a counter affidavit works, we must first address a billing affidavit. Under Section 18.001 of the Texas Civil Practice & Remedies Code, a plaintiff may outline why their medical expenses were reasonable and necessary. The plaintiff files a billing affidavit with their medical provider in an effort to prove that the treatment received and costs incurred were justifiable. Then, a defendant may file a counter affidavit to oppose the necessity or reasonableness of the charges outlined by the plaintiff. It is further justifiable, based on the Texas Supreme Court Decision Re. Allstate Indemnity Company No. 20-0071 (COA Docket No: 13-19-00346-CV) that clarified rules related to medical billing affidavits, whereby non-doctors (including billing experts and nurses) can provide expert testimony, provided the party seeking to use such testimony establishes the expert’s knowledge, skill, experience, training, credentials, or education regarding the medical issue. In many cases, counter affidavits will be strengthened by medical or billing/coding experts or other individual specialists with knowledge of the specific medical specialty.
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When Counter Affidavit Services May Be Necessary
There are several scenarios when getting medical or billing/coding expert witnesses involved via counter affidavits may be in your client's best interest. Every situation is unique, and it is essential to fully understand the specifics of the case before seeking medical/legal experts. However, here are a few general examples of times when counter affidavits could be helpful:
- There are charges for services that were not administered or documented
- A physician billed for expenses they did not incur themselves
- The charges are extremely high—so much so that even a non-expert would question their reasonableness
- A medical professional billed several times for one procedure
- Healthcare providers neglected to file claims with the patient's health insurance
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Reviewing for Potential Counter Affidavits
Not all counter affidavit testimony is created equal. Before proceeding, attorneys need to consider a few review thresholds to ensure that it is the proper course of action. To begin with, attorneys need to look at the total amount of provider charges in question. If it is below $1,500, it may be a good idea to talk with the client and discuss whether a review is warranted. Other aspects to review when considering counter affidavits include:
- Documentation: Attorneys should take a look at detailed, itemized billing statements that record dates of service and list required 5-digit CPT codes for professional medical services. They should also review UB-04s for inpatient hospital billing.
- Medical History: The individual's medical history may need to be considered when determining whether service charges are medically necessary.
- Time: Counter Affidavit reviews usually require booking of at least two weeks in advance.
- Resources: Billing/coding experts utilize third-party UCR data derived from over a billion claim transactions and apply appropriate coding reimbursement criteria (edits, modifiers, unbundling principles).
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Connecting Attorneys With Medical and Billing/Coding Experts
Whether you are interested in getting a counter affidavit for your client or have another matter you wish to address, Juris Medicus is here to help attorneys find reliable medical and billing expert witnesses in Texas. We have years of experience and working relationships with more than 425 medical experts who may be able to strengthen your case. Our team is glad to facilitate attorney/expert communication and provide project coordination services. Our licensed, board-certified, or board-eligible experts come from more than 85 specialties and subspecialties, including but not limited to the following:
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Request Our Services Today
If a counter affidavit sounds like something that could strengthen your client's case, be sure to reach out to Juris Medicus. We are happy to connect Texas attorneys with seasoned medical and billing/coding professionals who understand the complexities of the field. You can depend on us and the thorough vetting process each of our experts undergoes. Contact us today to learn more about Counter Affidavits and to start connecting with a local medical and or billing expert.