Category: Medical Peer Review

Medical peer review is a significant process with regard to claims settlement by an insurance company. Stay connected with MOS for latest blog

Rajeev Rajagopal August 21, 2019 0

A medical peer review is initiated by a health insurer to determine whether the medical treatment provided for a covered person is compensable or not. An insurance denial may occur due to certain specific reasons and these are outlined in the EOB or the Explanation of Benefits document the insurer sends to the claimant. A […]

Julie Clements March 6, 2019 0

A medical peer review involves the review of a patient’s medical records by a physician, who provides an opinion based on the facts provided in those records. The peer review is presented in the form of a written report. An insurance company or payer that is not sure whether the treating physician’s diagnosis or treatment […]

Rajeev Rajagopal February 25, 2019 0

Insurers ask for a medical peer review when they are not sure whether a claim should be accepted and whether the treatment provided was medically necessary. This review process helps in avoiding fraud and reducing healthcare costs. However, there is often a tussle between the insurance company and the covered individuals if the claim is […]

Julie Clements February 18, 2019 0

Insurance fraud is a grave problem in America, costing insurance companies and their customers more than $40 billion a year, according to the FBI. This is excluding medical insurance fraud, which is estimated to cost tens of billions more. Typically, insurers utilize medical peer review to determine whether the treatment provided to a claimant was […]

MOS Medical Reviews January 2, 2019 0

Errors in medical records are common and could lead to devastating consequences for patients. The mistakes in electronic health records are becoming an increasing source for medical malpractice claims, which necessitates formal procedures such as medical peer review. A recent CNBC report shows that about 70% of patient records have wrong information and patients often […]

Rajeev Rajagopal November 28, 2018 0

A medical peer review for insurers is typically performed to determine whether the services provided by the treating physician to the patient were medically necessary. This is an important procedure which helps to identify and prevent insurance fraud. However, it is also essential to ensure that legitimate insurance claims are not denied. Unfortunately, studies show […]

Julie Clements July 4, 2018 0

EHR systems are a force to reckon with for a large number of healthcare providers. While the convenience and efficiency offered by these systems are encouraging, there are complexities that are overwhelming for physicians. For instance the ease of access and sharing patient data enabled by the EHR is a great option for medical peer […]

Workers’ compensation insurance covers most on-the-job injuries and illnesses related to one’s work. Attorneys handling workers’ compensation cases utilize the service of medical record retrieval companies to collect all relevant medical records that are required to prove the injury or illness. Medical peer review, which is a key component of UR or utilization review is […]

Julie Clements February 27, 2017 0

Medical peer review is an indispensable service for insurers to ensure that claims are justly handled, not unfairly declined and settled in a timely manner. It helps them capture independently verified data that would help demonstrate that insurance claims have been settled fairly. Typically, health insurers make their coverage decisions on the basis of the […]

Julie Clements June 27, 2016 0

A medical peer review involves the review and analysis of an insurance claimant’s medical records written by his/her treating physician by another physician employed by the insurance company. This is primarily conducted to determine whether the services rendered by the treating physician to the patient were medically necessary. Claim denials occur when the peer review […]

 

     

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