Medical Billing Analysis

Litigation-Ready Medical Bill Audits in Minutes

14 minutes with CaseMark

Run this workflow

Run it in CaseMark

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
Case 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. Every charge is validated against clinical documentation, benchmarked for reasonableness, screened for causation, and checked for billing irregularities—with every finding cited to document, page, and Bates number.

Manually auditing medical bills for litigation is one of the most time-intensive tasks in personal injury and medical malpractice practice. Attorneys and paralegals must cross-reference hundreds of line items against medical records, verify code accuracy, benchmark charges against UCR data, and hunt for billing irregularities—all while ensuring every finding is documented with precise citations. A single missed flag can understate the case or hand opposing counsel impeachment material.

CaseMark automates the entire medical billing audit workflow. The AI ingests bills and medical records together, validates every code against the clinical documentation, runs reasonableness benchmarks, applies causation screening, and surfaces unbundling, upcoding, duplicates, and phantom charges. The result is a Bates-cited memo ready for deposition, mediation, or trial—produced in minutes instead of days.

How it works

1. Upload medical bills, supporting medical records, and case details
2. AI validates every CPT/HCPCS/ICD-10 code against the clinical documentation and screens each charge for causation
3. The system runs reasonableness benchmarks, detects billing irregularities, and identifies lien interfaces—citing every finding to document, page, and Bates number
4. Review the litigation-ready memo and export in your preferred format (DOCX, PDF)

What you get

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

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 flagging and chargemaster markup analysis
Collateral-source and lien interface identification with Bates-cited findings

Required documents

Medical Bills
Itemized medical bills from all treating providers, including CPT/HCPCS codes, ICD-10 diagnoses, and billed amounts
.pdf, .docx, .xlsx
Medical Records
Complete medical records from all providers (ER, surgical, imaging, PT/OT, pain management, pharmacy, DME) supporting the billed treatment
.pdf, .docx
Case Summary
Incident details including date, mechanism of injury, body parts claimed, jurisdiction, and liability posture
.pdf, .docx, .txt

Supporting documents

Explanation of Benefits (EOBs)
Insurance EOBs or payment records showing billed vs. paid amounts for reconciliation analysis
.pdf, .docx
Letter of Protection
Any letters of protection issued to treating providers for LOP inflation analysis
.pdf, .docx
Prior Medical Records
Pre-incident medical records for the same body parts to support causation screening and pre-existing condition analysis
.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 bill-by-bill review with automated CPT/ICD-10 validation and reasonableness benchmarking

Catch revenue-inflating tactics like unbundling, upcoding, and letter-of-protection markup before opposing counsel does

Produce exhibit-ready memos with granular Bates-cited findings that withstand deposition and trial scrutiny

Identify lien interfaces and collateral-source issues early to avoid downstream surprises in settlement or verdict

Questions

What types of cases does this medical billing analysis support?

CaseMark's medical billing analysis is designed for personal injury, medical malpractice, workers' compensation, and disability cases. The output is structured to serve as an exhibit-ready memo for depositions, mediations, and trial.

How does the AI validate CPT and ICD-10 codes?

CaseMark cross-references every billed CPT, HCPCS, and ICD-10 code against the uploaded medical records to confirm that the documented treatment supports the code. Mismatches, unsupported codes, and documentation gaps are flagged with specific citations.

Does the analysis detect unbundling and upcoding?

Yes. CaseMark applies NCCI-informed logic to identify unbundled procedure codes, upcoded E/M levels, duplicate charges, and phantom billing entries. Each flag includes the relevant line items and supporting record citations.

How does the reasonableness review work?

The analysis benchmarks billed amounts against UCR data, FAIR Health percentiles, and the Medicare Physician Fee Schedule. Charges that exceed reasonable thresholds are flagged with the applicable benchmark and the percentage variance.

Are findings cited to specific documents and pages?

Absolutely. Every finding in the CaseMark memo cites the source document, page number, and Bates stamp so attorneys can verify and use the analysis directly in litigation without additional research.

Can this analysis identify liens and collateral-source issues?

CaseMark identifies Medicare, Medicaid, ERISA, hospital, and other lien interfaces within the billing records and flags collateral-source implications. Detailed lien resolution is handed off to a dedicated lien-resolution workflow.