In a much-anticipated opinion, the Texas Supreme Court delivered a decisive victory for Juris Medicus’ billing and coding experts, blocking the growing trend of challenges to such experts who controvert medical expense affidavits. The Court provided much-needed clarification on Section 18.001 of the Texas Civil Practices and Remedies Code and held:
- 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.
- Section 18.001(f) does not require counter-affidavits to satisfy the standards for admissibility under Rule 702 or Robinson; thus, challenges to relevance and reliability are not proper grounds to strike a counter-affidavit.
- There is no exclusionary sanction for failure to comply with Section 18.001(f); 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, its counsel, and its clients have been among many groups advocating for the position now endorsed by the Texas Supreme Court. The results of these coordinated efforts were almost immediate. In the days and even hours following the opinion’s release, Juris Medicus’ clients reported that pending motions to strike were withdrawn and hearings were dropped. The watershed decision should continue to have a significant impact on a party’s ability to challenge Juris Medicus’ billing and coding experts, who have credentials similar to those held by the expert in Allstate and utilize the same database (Context4Health).
A courtesy copy of the Allstate opinion is linked.
