Medical records help to decide the value of a case. These records should be accurate, complete, and contain the history, conditions and treatment of the patient. Getting the records together in properly organized format and reviewing them is crucial when it comes to matters of litigation. Medical record review is important for insurance companies, law firms, chart review and medical review firms, independent reviewers, physicians and other organizations. They have to conduct reviews to determine the appropriateness of care provided and the timeliness of such care.
When Medical Record Review is Necessary
Efficient medical-records solutions are necessary when dealing with the following cases:
• Most kinds of personal injury litigation
• Different types of tort litigation such as negligence, medical malpractice, intentional torts, strict liability, and products liability
• Workers’ compensation
If a person is injured through medical negligence, he must prove his damages so that he can make a valid claim. The first documents that his attorney will want are his medical records. The attorney will have to conduct medical claims review so that he can provide evidence of his client’s medical injuries and win the case for reimbursement. Medical record reviews offer a clear insight into the medical aspects of a case and is a vital for the preparation of the case.
If it is a case of worker’s compensation, there must be proof of the injury in the workplace, and here too, the lawyer has to review the medical records to get important information and summarize it for the case.
Medical peer review is another instance when hospital patient records are reviewed. This is done by a physician advisor or the quality assurance department in a hospital to evaluate whether a particular physician has complied with the accepted standards of care, or whether there has been any malpractice or negligence.
Insurance companies need accurate medical record reviews to determine for necessity of treatment received by their client following an accident. This will help in the settlement of claims and to prevent fraud. Insurers may also need such reviews to verify information in a life insurance claim.
What the Review Involves
The review of these records involves the examination of the records of discharged patients to understand the necessity and timeliness of the various aspects of care. This means the chronological arrangement of physician’s notes, laboratory tests, nurses’ notes, medical bills, vital signs, physician’s orders, consultant reports, x-ray reports, and much more. Everything has to labeled and arranged according to date and time. The various tasks involved are:
• Collection and classification of the required information
• Checking for missing medical records/documents
• Medical chart review
• Chronological listing of records
• Indexing of medical records
• Compliance checks
• Information in comprehensive format
• Medical case summary and history
Importance of Accuracy
The medical record review is important to prove that the records of a patient support his allegations about the physical injuries he has suffered. If this is proved, the reviewer must also check the extent of the patient’s injury and whether he is claiming the proper amount of medical compensation. It is therefore of utmost importance that the medical record review is accurate.
Busy independent attorneys, law firms, medical review firms, and others can save time and money and ensure accuracy in the review process by entrusting the work to professionals. Many outsourcing companies in the US offer efficient support services following medical review criteria guidelines. These affordable services go a long way in helping their clients reduce their workload and improve their cash flow.
Medical Record Review – Managed Outsource Solutions provide a range of medical review services to facilitate easy access to patient case information.