What is Medical Review?
Medical review is an essential part of the medical industry.
Medical review processes identify aberrancies or patterns of inappropriate
billing, educating providers on Medicare coverage and coding requirements, and
performing medical review of claims and the supporting documentation.
Individual patients are often unaware of the role of a medical review. It is
vital for patients and medical practitioners to understand how a timely
medical review can save them time, money and anxiety. Medical review
transcription is one of the most sort-after areas of the allied health
industry, creating an important partnership between healthcare providers and
those who document the patient care. The industry is moving towards electronic
health records, so that it can be accessed by companies providing insurance
claims. Medical reviews are very essential documents. These reports can work
as legal documents and fulfill requirements for insurance reimbursements. They
also can be used as references for scientific research.
Filing a medical claim can be a tedious process prone to
miscommunication and breakdowns in the chain of paperwork. It can be done by
an independent review organization or the insurance company itself.
The following steps illustrate how a medical review works:
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A patient is being treated for a condition or injury. The
medical opinion of the attending physician along with related charts and
information is documented.
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Medical and physician resources are given the medical
information and are asked to review the treatment and the prescribed
recommendations.
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The medical specialist connected to the case will provide an
unbiased opinion with regard to the treatment.
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An insurance expert reviews the terms of the patient’s
coverage as offered by the insurance company. He will offer an unbiased
opinion whether the patient is covered for the treatment or not.
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Finally, the two opinions are checked to return an objective
recommendation for approval or denial.
This process allows for healthcare decisions to be made in a
timely and expert fashion by experts from both sides of the equation. An
insurance expert understands the complex terminology of a medical review and a
specialized physician understands the nature of illness and treatment. This
combination of expertise speeds the process of treatment review and coverage
approval.
Some types of medical reviews are listed:
