What is Review of Records?
Review of records or medical record review is a comprehensive assessment or detailed analysis of the medical records of a patient, which may comprise a physician or nurse notes, diagnostic reports, discharge summary, correspondence between medical professionals, hard copies of monitoring equipment, and computerized database. Medical record reviewers identify, review, interpret and analyze various elements in a patient’s medical record for medical and legal purposes.
Medical record review is also crucial for management of medical claims. Health insurance providers such as Medicare and Medicaid, Workers’ compensation, and other insurance companies will have a claimant’s medical records reviewed by a medical provider for validating medical claims in order to determine initial or ongoing eligibility for benefits. A claim can be reimbursed appropriately or a disputed claim resolved satisfactorily only through an accurate review of the concerned medical records.
Process Involved in Review of Records
The process involved in the review of records includes:
- Collect, classify, and record medical information by type of data
- Establish the components of the patient’s medical record
- Retrieve information of the patient’s medical record
- Record information about medical care received, including medications, procedures, and other forms of treatments and arrange in an orderly fashion
- List all objective medical tests performed, such as X-rays
What Does a Medical Record Reviewer Do?
A record reviewer carries out the following responsibilities:
- Review information for accuracy, compliance, and completeness
- Index and sort the medical records, classify and summarize them appropriately
- Categorize relevant information in the medical records based on the provider of service, place of service, date of service, and type of service received
- Develop medical information in a chronological and time-line specific fashion for client case needs
- Arrange for medical records to be provided in an electronic format
Uses of Review of Records
Review of records may serve the following:
- Insurance claims
- Health plans
- Social security disability claims
- Medical legal consultants
- Independent medical examiners
- Private physician practices
- Law firms
Medical records are repositories of a patient’s medical history and treatment procedures. Through a review of records, health care professionals can track the progress of treatments, check the efficacy of medications, and make informed decisions on a patient’s condition. Medical records can also help health professionals during audits for liability and malpractice. Usually, personal injury lawsuits, disability cases, fraud investigations, workers’ compensation claims, and medical malpractice cases involve a detailed review of medical records. Given the medical legal significance of medical records, it is imperative that details of every patient encounter are recorded in the medical records and preserved for the client needs.