Medical Billing Analysis
Produces a litigation-ready analysis of medical records and billing data for personal injury cases. Every finding is cited to a specific document and page. Output supports demand packages, mediation statements, and trial preparation.
Quick Start
- Gather records and billing from the user (or confirm what's uploaded)
- Build document inventory and medical timeline
- Analyze billing, check reasonableness, trace causation
- Flag red flags, deliver structured report
- Align with user on gaps and next steps
Intake (Mandatory)
Ask every time unless user says "use defaults" or "just draft":
- Medical records — treatment notes, diagnostics, surgical records, discharge summaries, pharmacy records
- Billing statements — itemized bills from all providers, EOBs, insurance payment records
- Incident information — date, mechanism of injury, pre-existing condition history
- IME or peer review reports (if available)
Request if missing: provider itemized bills (not just totals), EOBs, lien statements (Medicare/Medicaid/ERISA/hospital), pre-incident records if pre-existing conditions at issue, life care plan if available.
Defaults when user doesn't respond: analyze all provided records chronologically; flag treatment gaps > 30 days; separate billed vs. paid; identify causation statements. Label defaults clearly.
Flag missing materials explicitly and proceed with what's available.
Workflow
1. Document Inventory
Classify each document:
| Category |
Examples |
| Emergency/acute care |
ER records, ambulance reports |
| Inpatient |
Hospital admissions, surgical notes |
| Outpatient/specialist |
Orthopedic, neurological, pain management |
| Diagnostic imaging |
X-ray, MRI, CT reports |
| Therapy |
PT, OT, chiropractic, psychological |
| Pharmacy |
Prescription records, medication logs |
| Billing/financial |
Itemized bills, EOBs, lien statements |
| IME/peer review |
Defense or insurance medical evaluations |
2. Medical Timeline
Build chronological table with: Date, Provider/Facility, Visit Type, Diagnoses (ICD), Procedures (CPT), Key Findings, Restrictions/Prognosis.
Flag: gaps > 30 days, diagnosis changes, new providers/referrals, causation statements by treating physicians, pre-existing condition references, work/activity restrictions.
3. Billing Analysis
Catalog charges with: Date, Provider, CPT/Code, Description, Billed, Insurance Paid, Adjustment, Patient Owed.
Summarize totals by category: emergency, hospitalization/surgery, imaging, therapy, medications, mental health, ongoing/future care.
4. Reasonableness Review
For each major charge category, verify:
- Charges consistent with geographic/specialty norms
- No duplicate billing for same service/date
- All billed services have corresponding documentation
- Treatment consistent with documented diagnoses
- No unrelated-condition charges without explanation
5. Causation Analysis
- Direct causation — quote treating physicians verbatim with doc/page citations
- Pre-existing conditions — documented history; aggravation vs. new injury distinguished
- Conflicting opinions — disagreements between treating, IME, and peer reviewers
- Treatment necessity — provider statements on reasonable and necessary care
6. Red Flags
Flag items requiring attorney attention in a table: Issue, Details, Source (doc/page), Suggested Action.
Common flags: treatment gaps, billing without documentation, causation disputes, charges above area norms.
7. Final Report
Deliver a single report with these sections:
Front matter (required):
- Documents reviewed with date ranges
- Assumptions and limitations
- Open items (requested but not received)
Body:
- Document Inventory
- Medical Timeline (chronological table)
- Treatment Summary (narrative: injuries, treatment course, current status)
- Billing Summary (category totals with line-item detail available)
- Causation Analysis (supported chain with citations)
- Issues and Red Flags (table with recommended actions)
- Expert Needs (life care planner, billing expert, medical specialist)
Post-Draft Alignment (Mandatory)
After delivering the initial analysis, ask:
- Additional providers or records not yet received?
- Client explanations for treatment gaps?
- Specific causation disputes to analyze deeper?
- Future care cost projection needed?
If no response, recommend obtaining missing provider records and proceed if authorized.
Quality Checklist
Rules
- Cite document and page for every factual finding
- Never opine on liability or damages awards
- Distinguish treating physician documentation from IME/defense opinions
- Flag but do not resolve billing disputes — identify for attorney review
- Do not invent findings, diagnoses, causation opinions, or citations
- Include scope notice: "Draft analysis requiring attorney review. Figures based on provided documentation and stated assumptions."
1---2name: medical-billing-analysis3description: >4 Analyzes medical records and billing data for personal injury litigation,5 producing a chronological report with treatment details, costs, causation6 chains, and red flags. Trigger when the user requests medical billing analysis,7 medical records review, treatment timeline, billing reasonableness review,8 causation analysis, damages documentation, PI case valuation, ICD/CPT code9 review, IME rebuttal prep, or needs to organize medical evidence for a demand10 package or mediation statement.11tags:12 - analysis13 - litigation14---1516# Medical Billing Analysis1718Produces a litigation-ready analysis of medical records and billing data for personal injury cases. Every finding is cited to a specific document and page. Output supports demand packages, mediation statements, and trial preparation.1920## Quick Start21221. Gather records and billing from the user (or confirm what's uploaded)232. Build document inventory and medical timeline243. Analyze billing, check reasonableness, trace causation254. Flag red flags, deliver structured report265. Align with user on gaps and next steps2728## Intake (Mandatory)2930Ask every time unless user says "use defaults" or "just draft":31321. **Medical records** — treatment notes, diagnostics, surgical records, discharge summaries, pharmacy records332. **Billing statements** — itemized bills from all providers, EOBs, insurance payment records343. **Incident information** — date, mechanism of injury, pre-existing condition history354. **IME or peer review reports** (if available)3637**Request if missing:** provider itemized bills (not just totals), EOBs, lien statements (Medicare/Medicaid/ERISA/hospital), pre-incident records if pre-existing conditions at issue, life care plan if available.3839**Defaults when user doesn't respond:** analyze all provided records chronologically; flag treatment gaps > 30 days; separate billed vs. paid; identify causation statements. Label defaults clearly.4041Flag missing materials explicitly and proceed with what's available.4243## Workflow4445### 1. Document Inventory4647Classify each document:4849| Category | Examples |50|---|---|51| Emergency/acute care | ER records, ambulance reports |52| Inpatient | Hospital admissions, surgical notes |53| Outpatient/specialist | Orthopedic, neurological, pain management |54| Diagnostic imaging | X-ray, MRI, CT reports |55| Therapy | PT, OT, chiropractic, psychological |56| Pharmacy | Prescription records, medication logs |57| Billing/financial | Itemized bills, EOBs, lien statements |58| IME/peer review | Defense or insurance medical evaluations |5960### 2. Medical Timeline6162Build chronological table with: Date, Provider/Facility, Visit Type, Diagnoses (ICD), Procedures (CPT), Key Findings, Restrictions/Prognosis.6364Flag: gaps > 30 days, diagnosis changes, new providers/referrals, causation statements by treating physicians, pre-existing condition references, work/activity restrictions.6566### 3. Billing Analysis6768Catalog charges with: Date, Provider, CPT/Code, Description, Billed, Insurance Paid, Adjustment, Patient Owed.6970Summarize totals by category: emergency, hospitalization/surgery, imaging, therapy, medications, mental health, ongoing/future care.7172### 4. Reasonableness Review7374For each major charge category, verify:75- Charges consistent with geographic/specialty norms76- No duplicate billing for same service/date77- All billed services have corresponding documentation78- Treatment consistent with documented diagnoses79- No unrelated-condition charges without explanation8081### 5. Causation Analysis82831. **Direct causation** — quote treating physicians verbatim with doc/page citations842. **Pre-existing conditions** — documented history; aggravation vs. new injury distinguished853. **Conflicting opinions** — disagreements between treating, IME, and peer reviewers864. **Treatment necessity** — provider statements on reasonable and necessary care8788### 6. Red Flags8990Flag items requiring attorney attention in a table: Issue, Details, Source (doc/page), Suggested Action.9192Common flags: treatment gaps, billing without documentation, causation disputes, charges above area norms.9394### 7. Final Report9596Deliver a single report with these sections:9798**Front matter (required):**99- Documents reviewed with date ranges100- Assumptions and limitations101- Open items (requested but not received)102103**Body:**1041. Document Inventory1052. Medical Timeline (chronological table)1063. Treatment Summary (narrative: injuries, treatment course, current status)1074. Billing Summary (category totals with line-item detail available)1085. Causation Analysis (supported chain with citations)1096. Issues and Red Flags (table with recommended actions)1107. Expert Needs (life care planner, billing expert, medical specialist)111112## Post-Draft Alignment (Mandatory)113114After delivering the initial analysis, ask:1151161. Additional providers or records not yet received?1172. Client explanations for treatment gaps?1183. Specific causation disputes to analyze deeper?1194. Future care cost projection needed?120121If no response, recommend obtaining missing provider records and proceed if authorized.122123## Quality Checklist124125- [ ] Every finding cites specific document and page126- [ ] Timeline complete and chronological, no unexplained gaps127- [ ] Billing totals reconcile (billed = paid + adjustments + patient owed)128- [ ] Causation statements quoted verbatim with citations129- [ ] Pre-existing conditions distinguished from incident-related injuries130- [ ] Duplicate charges identified and flagged131- [ ] IME/defense opinions cataloged separately from treating physician findings132- [ ] Missing records noted, not assumed133- [ ] Dollar amounts consistent (no mixed rounding)134- [ ] Future care costs itemized separately if projected135- [ ] No opinions on ultimate legal conclusions136137## Rules138139- Cite document and page for every factual finding140- Never opine on liability or damages awards141- Distinguish treating physician documentation from IME/defense opinions142- Flag but do not resolve billing disputes — identify for attorney review143- Do not invent findings, diagnoses, causation opinions, or citations144- Include scope notice: "Draft analysis requiring attorney review. Figures based on provided documentation and stated assumptions."
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