Settling medical claims often becomes a tough option for insurance companies when burdened with the responsibility of determining the legitimacy of submitted claims. They have to guard against insurance fraud and abuse, overpayments and losses and contain costs. The authenticity of a claim can be established only on the basis of a detailed review of the relevant patient medical records. While having an in-house team to handle the review process is possible, if you are looking for thoroughly professional medical record review, it is best to depend on an experienced medical review company. The workload associated with the review process in considerably reduced; moreover, the entire claims review process is speeded up.
Medical Record Review of Diverse Documents
The review process is made complicated by the sheer volume and diversity of the records involved. A variety of documents such as affidavits, X-rays, depositions, discharge summaries, physician records and more have to be reviewed. These have to be sorted and arranged into sections such as progress notes, laboratory notes, procedure notes, specialist consultations, diagnostic examination reports, hospital records, imaging reports and surgical reports. Once the records are organized and indexed, they are analyzed and reviewed to extract the most vital and relevant information pertaining to the medical claim. The reviewing is done by a professional team comprising doctors, paramedics and documentation specialists trained and experienced in the task.
• The medical case summary clearly highlights important aspects of the medical care provided, enabling the payer/attorney to understand whether the care provided has been appropriate and medically necessary. With the necessary information available at their fingertips, claim settlement becomes easy and efficient.
• When a professional medical review team is handling the task, there is no risk of missing information or failing to identify misleading data/data that has been tampered with.
How Medical Review Services Become Invaluable
Medical review services become invaluable mainly on account of being professional and accurate. Since any room for error is practically nil with a reputable medical record review company, insurance companies can make the correct decisions regarding particular claims. Other benefits offered that make such services invaluable are:
• HIPAA compliance
• A dedicated team of medical review professionals working on each client’s account
• Status reports are provided on a daily, weekly, and/or monthly basis
• Multilevel quality control and auditing
• Competitive pricing with attractive cost savings
• Customized turnaround according to client requirements
How to Identify a Reliable Medical Review Company
Look for listings of professional outsourcing firms offering medical review services. The provider should be capable of offering service for all major medical specialties. Decide on a medical review company that enjoys a good reputation and has many satisfied clients. Check out any free trial offer the firm may have and evaluate their service and turnaround time. If you are looking to save costs, go for a BPO firm that is based in the U.S, and has offshore facilities to ensure affordable services.