Medical Billing Analysis

Audit Medical Bills for Litigation in Minutes

14 minutes with CaseMark

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Upload your documents and get a finished work product in minutes. New accounts get $5 free to run their first skill.

14 minutes with CaseMark

What you'll need

Medical Bills
Medical Records
Incident Summary

SOC 2 Type II · HIPAA compliant · $5 free credit

Workflow

Overview

CaseMark's Medical Billing Analysis skill produces a comprehensive, litigation-ready audit of medical bills and supporting records for personal injury, medical malpractice, workers' compensation, and disability cases. It validates every CPT, HCPCS, and ICD-10 code against the clinical documentation, screens each charge for causation, benchmarks reasonableness against UCR/FAIR Health/MPFS data, and surfaces billing irregularities—all with precise document, page, and Bates citations.

Manually auditing medical bills for litigation is one of the most time-intensive tasks in personal injury and workers' compensation practice. Attorneys and paralegals must cross-reference hundreds of line items against medical records, verify CPT and ICD codes, check reasonableness against multiple fee schedules, and hunt for unbundling, duplicates, and inflated charges—all while ensuring every finding is properly cited for use at deposition or trial.

CaseMark automates the entire medical billing audit workflow, validating every code against the clinical record, applying causation screens, running multi-source reasonableness benchmarks, and flagging billing irregularities with a consistent taxonomy. The result is a Bates-cited, litigation-ready memo that strengthens your damages case and eliminates the risk of presenting unverified charges to opposing counsel or the court.

How it works

1. Upload medical bills, supporting medical records, and incident details
2. AI validates every CPT/HCPCS/ICD-10 code against the clinical documentation and screens each charge for causation
3. Review the litigation-ready memo with flagged red flags, reasonableness benchmarks, and Bates-cited findings
4. Export the final analysis as DOCX or PDF for demand packages, mediation, or trial exhibits

What you get

Executive Summary & Key Findings
Per-Charge Line-Item Analysis with Code Validation
Causation Screening Results
Reasonableness Review (UCR/FAIR Health/MPFS Benchmarks)
Billing Red Flags (Unbundling, Upcoding, Duplicates, Phantom Charges)
Letter-of-Protection & Chargemaster Markup Analysis
Collateral-Source & Lien Interface Identification
Billed vs. Paid Reconciliation
Appendix of Citations with Document, Page & Bates References

What it handles

Per-charge CPT/HCPCS/ICD-10 code validation against medical records
UCR/FAIR Health/MPFS reasonableness review with benchmark comparisons
Unbundling, upcoding, duplicate, and phantom billing detection
Causation screening linking each charge to the incident
Letter-of-protection inflation and chargemaster markup flagging
Collateral-source and lien interface identification with Bates citations

Required documents

Medical Bills
Itemized medical bills from all treating providers, including CPT/HCPCS codes, ICD-10 diagnosis codes, and billed amounts
.pdf, .docx, .xlsx
Medical Records
Supporting clinical records from all providers (ER, operative notes, imaging reports, therapy notes, pharmacy records, DME orders)
.pdf, .docx
Incident Summary
Case facts including incident date, mechanism of injury, claimed body parts, jurisdiction, and liability posture
.pdf, .docx, .txt

Supporting documents

Explanation of Benefits (EOBs)
Insurance EOBs or payment summaries showing billed vs. paid amounts and adjustments
.pdf, .docx
Letters of Protection
Any letters of protection issued to treating providers for LOP inflation analysis
.pdf, .docx
Prior Medical Records
Pre-incident treatment records for the same body parts to support causation screening
.pdf, .docx
Lien Notices
Medicare, Medicaid, ERISA, or hospital lien notices for lien interface identification
.pdf, .docx

Why teams use it

Eliminate hours of manual code-by-code bill review with AI-driven validation that catches unbundling, upcoding, and phantom charges

Strengthen your damages case with defensible reasonableness benchmarks and per-charge causation screening

Reduce impeachment risk by proactively flagging pre-existing treatment, LOP inflation, and chargemaster markup

Produce exhibit-ready memos with every finding tied to specific Bates numbers for immediate use in demands, mediations, and trial

Questions

What types of billing issues does this analysis detect?

CaseMark's medical billing analysis detects unbundling, upcoding, duplicate charges, phantom billing, chargemaster markup, and letter-of-protection inflation. Every flagged issue is categorized with a stable taxonomy ID and cited to specific document pages and Bates numbers.

Does the analysis include reasonableness benchmarks?

Yes. CaseMark runs each charge through UCR, FAIR Health, and Medicare Physician Fee Schedule (MPFS) reasonableness frameworks, providing benchmark comparisons so you can assess whether billed amounts are defensible at deposition or mediation.

How does the tool handle causation screening?

Every charge undergoes a per-line causation screen that links the billed service to the incident's mechanism, date, and claimed body parts. Pre-existing same-body-part treatment is flagged so counsel can address it proactively rather than face impeachment.

Can I use the output directly in a demand package or mediation statement?

Absolutely. The memo is designed as a litigation-ready exhibit with every finding citing document, page, and Bates number. It integrates seamlessly into demand packages, mediation statements, and trial exhibits produced by CaseMark's downstream skills.

What if I have records from many different providers?

CaseMark handles multi-provider cases—ER, inpatient, imaging, PT/OT, chiropractic, pain management, behavioral health, pharmacy, and DME records can all be uploaded. The analysis reconciles charges across providers and identifies overlapping or duplicated billing.

Does this skill resolve liens or calculate total damages?

No. CaseMark's medical billing analysis is billing-side only—it identifies lien interfaces and collateral-source issues but hands lien resolution and damages valuation to dedicated sibling skills, ensuring each analysis stays focused and accurate.