Medical records review involves an accurate assessment of a complete set of medical records pertaining to a person for medical or legal purposes. It is a significant process for healthcare providers, and helps evaluate the care given to their patients. Lawyers / litigators handling personal injury, workers’ compensation, social security disability, medical malpractice and product liability cases, insurance claims and fraud investigations also require an accurate review of the plaintiff’s medical records. Plaintiff as well as defense attorneys can use the medical data abstracted from the records to support their clients or defend their clients against various claims.
Here are some important FAQs related to the medical records review process.
It helps attorneys understand the medical data within the records more easily and prepare their case well. Medical record summarization is valuable for insurance underwriters also, who need to review the APS (Attending Physician Statement). These physician statements are usually lengthy and contain complex as well as obsolete information. A medical case summary helps by providing a precise account of important medical data such as the patient’s medical history, including diagnostics, medical examinations, prescription medications, lab test findings, vital signs and so on.
A professional medical record review report is prepared in keeping with the requirements of the counsel and their litigation strategy. Abstraction of the medical data helps to weed out meritless claims, and also helps with early decision-making support as regards strategy and budget. Medical record review helps to detect tampered medical records, illegible records, and also identify and catalog additional providers of care.
Insurance companies require chart review for medical claims processing. The process helps them validate medical claims submitted by healthcare providers, and determine the medical necessity of services provided to a patient. Also, the review helps to identify expensive procedures that are routinely performed, outdated medical codes, and medical billing and coding inconsistencies such as over billing.