Establishing Medical Necessity via Medical Chart Review [Infographic]

Misrepresenting treatments is one of the most common forms of health insurance frauds.  When treatments that are not covered as medically necessary are misrepresented, it makes medical record review a very important consideration. When evaluating a patient’s health record, a medical record review company would scrutinize all visits, including telemedicine encounters, especially physical therapy and chiropractic services. Medical record review helps ensure that the patient received the right treatment for his/her particular health condition. Such review can help attorneys identify manipulations in the claim that suggest possible fraud. Claiming for medically unnecessary treatments leads to increase in the overall cost of hospitalization. A comprehensive medical chart review would clearly identify the patient and whether he or she is being provided the care identified on each chart entry, and ensure that all entries are legible and dated, and complete.

Check out the infographic below