What Is Medical Record Review?

by | Published on Jan 13, 2023 | Medical Record Review

Medical record review involves evaluating a patient’s healthcare information for medical or legal purposes. It is the process where a reviewer reviews medical charts to ensure they are complete or accurate, or to collect important medical facts from those records.

Medical records contain all the significant information about the patient’s diagnosis, medical and social history, and the various tests and imaging studies conducted.

Who needs it the most?

Lawyers, insurers and healthcare entities require this service the most.

Insurance companies require their applicants to undergo a medical exam and/or submit their medical records, before issuing any policies and determining premiums for healthcare coverage. Medical record review helps to determine medical necessity for a healthcare service or procedure. Record review also reveals any pre-existing medical conditions of the applicant, family medical history, and other details that can impact the coverage amount and premium. Medical record analysis will help the insurer determine the value of a claim. Typically, claimants who cannot work due to a disabling injury need to prove that the injury or condition is grave. If this cannot be established via a medical record review, the claim may be minimized or even denied. Insurance adjusters may also review the medical records periodically to show that the claimant is no longer disabled. In such cases, they will discontinue the benefits.

While primarily important from the viewpoint of ensuring appropriate medical services and care for the patient, the medical record is also a legal document. When it comes to the medico legal side, if someone is involved in a car accident or is injured due to another’s fault, he/she may receive due compensation. Law firms or attorneys dealing with lawsuits related to personal injury, medical malpractice, mass tort or workers’ compensation have to handle voluminous medical records to understand the medical issues in the case. For attorneys, medical record review is important to

  • understand the various medical aspects of the case they are handling
  • determine the nature and extent of damages for the claimant
  • understand the strengths and weaknesses of the case

Different medical record review services

  • Medical records organization
  • Case chronology support
  • Plaintiff fact sheet preparation
  • Deposition summaries
  • Case history and summary
  • Chart and bill review
  • Trial preparation

What are the challenges involved in chart review being done in-house?

A medical record review should provide clear, accurate, chronological, consistent and complete details about the patient care provided.

When done in-house, medico-legal entities may face many challenges. They may find it difficult to deal with –

  • Handwritten notes and illegible handwriting
  • Difficult-to-understand abbreviations and jargon
  • Different charting systems
  • Incomplete medical records
  • Lack of meaningful information on EHRs
  • Poor chronological order

The entire process can be made easier with support from a good provider. Experienced legal nurse consultants at professional companies can do the medical record analysis and review in short time. They have expertise in reviewing thousands of medical records for litigation and claim handling requirements.

Why outsource record review tasks?

Managing a medical review team in-house costs much more than outsourcing the task. To manage the process in-house, medico-legal sectors have to invest in infrastructure and technology from time to time, pay the hired paralegal staff and provide them additional benefits. Another concern is that if the team is not skilled and knowledgeable in handling large-volume medical records, the process will become more time-consuming and complex. For attorneys, delay in review will delay the trial preparation as well, which will affect the firm’s workflow.

Without proper training, paralegals, reviewers and other staff in the team may not be up-to-date with the changing record review standards and they may not be aware of the record related complexities and medical terminologies.

Due to these reasons, outsourcing to the right provider is the best option to obtain accurate reviews in the format desired.

Why MOS?

Managed Outsource Solutions (MOS) is a professional medical record review company with years of experience in providing medical review solutions for attorneys, chart review firms, insurance companies, and SSD firms.

MOS provides the services of skilled legal nurse consultants and reviewers to eliminate the difficulty of interpreting complex medical records. Our services include but are not limited to record retrieval, medical record review, chart audits, claims review, deposition summary, rebuttal preparation, and more.

With us, you can benefit from –

  • HIPAA compliance
  • Faster turnaround times
  • Dedicated team
  • Multi-level QA and audit trail
  • Free trial offer
  • Distinct time-zone advantage
  • Competitive pricing
  • Solutions in standard, personalized formats
  • State-of-the-art technological capabilities
  • Secured file transfer

Our nurse consultants ensure that all clinical data are identified and clearly highlighted, and all the facts relevant to your case are well-presented.

For reliable, on-time medical review services, talk to our team at 1-800-670-2809

Discover our medical record review solutions and partner with us for your next case.

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