JDM Records Review

Jennifer Murillo, CFMC, CPC, CPCO, CPMA, CMA. I am a Certified Forensic Medical Coder, Certified Professional Coder, Certified Professional Medical Auditor, and Certified Professional Compliance Officer via my education from AAPC, the American
Academy of Professional Coders.

I am a Certified CPC Instructor through AAPC and have
taught Medical Billing and Coding for over 14 years.

I serve as a Compliance Officer for a Physical Rehabilitation and Physical Medicine practice with multiple locations in the South Texas region that oversee the care of patients who are employed by the Department of Labor and have suffered on the job injuries.

I also served as the Compliance Officer for a Pediatric Medical
Group in the South Texas region.

I currently provide expert witness services for medical claims audits, billing review and compliancy in medical coding in Texas including the Houston, Austin, San Antonio, South Texas region, East Texas region, and surrounding rural and suburban areas.

I privately contract with attorney’s and medical offices in the Texas areas for review of medical billing pertaining to fraud/abuse with Federal Payers.

I coordinate with attorney offices and review medical records and medical claims, payer balances and patient balances prior to probating a Will, reviewing Life Care Plans, or prior to a court case.

I ensure reimbursement from the payers is in accordance with proper payment guidelines.

I have provided technical
assistance to staff in initiating billing procedures to appropriate billers such as Medicare and Medicaid, Worker’s Compensation, and private payers.

I create and maintain as a liaison with insurance companies to ensure timely and efficient payment of medical bills.

I was the Program  Coordinator/Chair for the Medical Coding and Billing, Medical Office Support and
Medical Assisting Programs at Austin Community College for four years and where I was an instructor since 2015. 

I have handled the oversight of medical billing accounts for Hospitalist/ Geriatricians and
Specialist. Also relying upon and using my knowledge, skill, experience, training, and education; I perform all aspects of medical billing and coding including but not limited to contract and medical fee negotiations and medical billing audits. 

I am qualified to provide an opinion regarding the Usual, Customary, and Reasonable cost of medical services based upon the records showing the service provided and the charges made in  specific geographical areas including the specific geographic areas that are at issue in this
instance. 

Based on my 20 years of knowledge and experience, education, and certifications I have developed an expertise in the specialty healthcare fields of medical coding, billing practices and reimbursement, practice management, compliance, and auditing.

I am keenly aware and familiar
with what medical providers charge for services in Texas, Oklahoma, and New Mexico. Most contracted allowable fee amounts are based on the Medicare allowable in a given geographic area plus an agreed upon percentage related to these Medicare allowable amounts.

As with all commercial payers, federal payer (Medicare/Medicaid/Tricare) allowable amounts are also based on the date of service and the geographical area.

I am familiar with the reasonable and customary billing practices, charges, and
reimbursements in the counties where the medical services were provided.

I am qualified by knowledge, skill, experience, training, and
education to opine on the medical expenses detailed hereto. To perform a billing and coding review, I first compare the billing/coding with the medical documentation to determine if the coding was properly applied. CPT codes are defined by the American Medical Association for
all medical services across the United States. In my analysis, I explain whether the coding was
properly applied, and if there was unbundling of services, or improperly utilized codes. To help with this process, I utilize Fair Health, Codify, Context4 Health and Find-A-Code databases.

These programs are utilized to support the analysis, and the findings reflected in this report by providing information on coding guidelines that further assist with defining reasonable
reimbursement for services rendered.

The references I use are comprised of healthcare regulatory requirements pertaining to coding, billing, documentation, and reimbursement information for

reference to include Current Procedural Terminology (CPT), Healthcare Common Procedure
Coding System (HCPCS), and conventions of International Classification of Diseases (ICD-10).