Medical Record Review for Medical Necessity
Professional medical record review services are useful for health insu rance companies to get a clear understanding of the m edical claims submitted for reimbursement. Claimin g for medically unnecessary treatments can lead to increase in the overall costs of hospitalization. Medica l claims review help identify fra udulent claims and medically unnecessary services.
A comprehensive review would check whether plans of action/treatment are consistent with the diagnosis (es)
for consultant summaries, imaging study and lab results are included to reflect primary care physician review
there is documented evidence of appropriate use of consultants
if chronology is maintained
there is documented evidence of continuity and coordination of care between primary and specialty physicians
whether informed consent is noted for all procedures and appropriate prescriptions
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