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What is the Importance of a Medical Record Review? Why Do Healthcare-Related Lawsuits Need Them?

An accurate review of the relevant medical records is vital when evaluating a medical or legal claim. Medical record review is a crucial process for lawyers and litigators while dealing with workers’ compensation, product liability, and social security disability cases; insurance claims; fraud investigations; medical malpractice cases; slip and fall and other personal injury claims. Medical record review is an important procedure in health systems to assess the care given for their patients.

The key evidence for most of the medico legal cases will be the electronic medical record of the injured person. As medical records contain information regarding patients’ diagnosis, medications, medical and social history, lab tests and evaluations done by medical specialists, they serve as clear evidence for lawyers and attorneys to substantiate insurance claims and win cases. Attorneys dealing with these cases will have to go through all available evidences in detail, which can be quite time consuming. A detailed review of the timelines is also crucial to correlate the events that occurred.

While attorneys and paralegals use medical record review to prepare for litigation, hospitals use this service to keep patient records organized for easy identification of any missing records and faster analysis. A hospital medical record includes History and physical reports, Progress notes, Lab reports, Assessments, Consults, Clinical reports, Authorizations and consents, X-rays, Fetal strips, Pathology slides, Other provider records, Patient-generated records and Personal health records. Hospitals and other health systems utilize medical record review to identify instances of harm to patients, ensure quality improvement and thereby enhance patient safety.

Accurate review of relevant medical records is also important for medical claims management. Constant monitoring of medical records is crucial for validating medical claims, calculating quality scores, and even for justifying various diagnoses. Hospital bills are also reviewed routinely to determine the medical necessity of services provided to a patient. The review helps to identify expensive procedures performed routinely, outdated diagnosis and procedure codes, over billing and other medical billing and coding inconsistencies.

Medical records that are not sorted out in chronological order can create confusion. When these electronic medical records are organized systematically, the reviewer can quickly and easily review the documents. Medical record review services provided by professional medical review companies are available to summarize these medical records into short, easily readable reviews that are sorted chronologically.

The process of record review often begins with the emergency department (ED) notes, or notes from emergency medical services (EMS). Review of diverse medical records will be required including physician visits, hospital visits, admission summary, discharge summary, operative summary, lab reports and more.

Medical record review services include:

  • Sorting, interpreting and organizing medical records
    Even highly complex medical records of various medical specialties can be sorted and physician notes or claimant interviews can be transcribed to organize records
  • Creating an accurate medical chronology/timeline
    Accurate chronology of medical encounters from the time of injury to the time of discharge will provide a clear view of the sequence of medical events
  • Creating medical case summaries
    Medical case summaries will provide a precise description of the nature of injury/condition, ER services, details of hospital stay, diagnoses, tests and treatments among other vital information
  • Identifying missing records and categorizing medical records
    Missing information or missing records need to be identified and they can be categorized into physician progress notes, operative records and so on

An experienced medical record review company can make the entire record review process simple and efficient. With easily accessible medical record reviews, attorneys and physicians serving insurers and the insured individuals can save considerable time and effort. However, these reviews have to be comprehensive, accurate, timely and adequate enough for the lawyers and paralegals that are not medically trained, to understand the medical aspects and prepare their case well. Similarly, timely review of medical records helps healthcare systems to evaluate the overall care given to their patients, identify risk areas, plan improvements and thereby offer a rewarding patient experience. Apart from this, regular monitoring and review of medical records will help avoid unnecessary expensive treatments and thus reduce healthcare costs.

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