Importance of Medical Record Review for Insurers

by | Published on Dec 9, 2022 | Podcasts

Managed Outsource Solutions (MOS) has years of experience providing medical record review services for insurance companies. Our medical review team comprises physicians and registered nurses who have the knowledge and insights to analyze the records and find sources of information beyond diagnoses, test results, and prognoses that may prove important to the defense.

In today’s podcast, Jessica Schwartz, one of our Solutions Managers, discusses why do insurers need medical record review.

Read Transcript

My name is Jessica. I’m the Solutions Manager for Managed Outsource Solutions and I’m here to talk to you about why do insurers need medical record review – with an infographic on our website.

Premiums of healthcare coverage may vary based on the health conditions of the applicant. Accurate review of medical records is important for insurance companies to help them ensure a fair claim settlement in personal injury, medical malpractice and other medical litigation. Insurance medical record review must be accurate for the insurers to prove fairness, medical necessity, fraud, embellishment, and up-coding among other aspects.

00:41 What Does the Medical Review Process Involve?

The medical review process involves a detailed analysis of the medical records of the claimant – admission notes, physicians’ notes, nursing notes, correspondence between healthcare providers, diagnostic tests, monitoring equipment printouts and so on. As insurance investigators and claim handlers may not be familiar with the complex medical jargon, it is ideal for insurers to consider the support of an experienced medical record review company. Reliable companies provide the service of experienced professionals who have good knowledge in organizing, interpreting, analyzing, and summarizing medical records.

Insurance defense attorneys also require proper review of medical records, as they have to work with insurance companies and their insured parties and insurance service organizations to provide comprehensive, efficient, and aggressive litigation services. They may have to deal with cases ranging from pre-suit investigation through the appeals process.

This medical history could have an impact on the claimant’s insurance costs, which is often revealed through a comprehensive review of his/her medical records.

Please check out our website for the infographic below

02:03 What are the Medical Records that Need to be Reviewed?

Insurers require review of these medical records

  • ER records
  • Nurses’ notes/Triage notes
  • Admission notes
  • Operative notes
  • Consultants’ records
  • Pathology reports
  • Radiology reports
  • Laboratory test reports
  • Occupational therapy/physical therapy reports
  • Discharge summary

02:23 Why Do Insurers Need Medical Record Review?

  • To verify information on insurance applications
  • To substantiate the details provided in the application
  • To reveal any pre-existing medical conditions of the applicant
  • To calculate the value of insurance claims
  • To understand the extent and severity of the claimant’s condition and
  • To help the insurer decide the value of a claim

Thank you for listening and we hope you have a wonderful rest of the day.

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

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