Tuesday, October 16, 2012

How Peer Review Companies Can Help Insurance Companies

Medical Peer Review

Payers initiate a peer review when they feel that the bill submitted by the medical service provider is excessive. The peer review will help determine whether the services provided were medically necessary. Peer review is very significant because accurate peer review helps to ensure that covered individuals received appropriate care, identify insurance fraud and control claims costs. Peer review companies are therefore a great support to insurance companies because they provide the services of expert professionals that manage the entire peer review process flawlessly.

Timely and Accurate Medical Peer Review Services

An important part of the peer review process is the collection and organization of all medical records pertaining to the medical claim. A reliable medical review company offers the services of a professional and experienced workforce that includes physicians and nurses among other support staff.

• The relevant medical records are organized chronologically to draw up an accurate timeline of all the medical encounters.
• The required information is extracted from the medical records and classified. A concise medical summary is prepared that gives a clear overview of all aspects pertinent to a case.
• The medical records are indexed.
• They are checked for compliance and thoroughness of data.
• If any medical records are missing, arrangements are made to locate those so that there is no confusion or ambiguity whatsoever regarding the care provided.

Peer Review Companies Ensure Comprehensive Medical Review Services

A dedicated peer review company focuses on providing objective and impartial services that will help identify whether the medical claims submitted are legitimate. Their medical review services enable speedy claims settlement and more streamlined functioning for the insurance company. Covered entities can be provided the appropriate care, while also ensuring that there is no overpayment in terms of unnecessary services. There are many other benefits that a dependable peer review firm offers:

• You receive round-the-clock service
• Documentation solutions are provided in the format of your choice
• Stringent QA procedures ensure accuracy and quality
• Absolute HIPAA compliance to ensure that all data entrusted remains confidential
• Customizable turnaround time, including immediate

Works as an Extension to Your Office

The greatest advantage of associating with a reliable peer review company is that the professionals there work just as your own staff. As a valued client, you stand to benefit from their experience and expertise. At the same time you also benefit from huge cost savings since you don’t need to recruit in-house staff to take care of the medical peer review process.

Peer review companies provide services that help insurance companies contain medical costs, and ensure the right care to the deserving patient. These services will also help detect insurance fraud and protect payers from excessive charges.

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