Comprehensive And Accurate Medical Peer Review Support Services

Insurance companies need to carefully scrutinize reimbursement claims related to complicated medical cases

. They appoint attorneys and physicians to conduct peer review to determine the medical necessity of treatment in general cases as well as those involving personal injury, medical malpractice, workers compensation and disability. This is a time-consuming and difficult task involving the review of all available medical records. Outsourcing companies now provide comprehensive and accurate medical peer review support services for litigation purposes, saving their clients time and money.

Efficient Physician Peer Review Services for Medico-legal Professionals

Physicians providing peer review services to the litigation industry have to assess the standards of care in complex medical cases and determine their medical necessity. What is medical necessity? The American Medical Association (AMA) defines Medical Necessity as health care services or products that a prudent physician would provide to a patient for the purpose of preventing, diagnosing, treating, or rehabilitating an illness, injury, disease or its associated symptoms, impairments or functional limitations in a manner that is: (1) in accordance with generally accepted standards of medical practice; (2) clinically appropriate in terms of type, frequency, extent, site and duration; and (3) not primarily for the convenience of the patient, physician or other health care provider.

Medical necessity can therefore be determined only by a thorough evaluation of the claimants medical records. This will help determine the specific clinical issues related to the case and whether they meet the criteria of the definition of medical necessity. The reviewing physician will examine whether there is subjective as well as objective data that warrants the treatment and items dispensed. Companies providing medical review services for the litigation industry assist the legal or medical professional by organizing and generating the documentation and reports necessary for peer review, including:

indexing, analyzing and arranging in chronological order all available physician records, depositions, and other office records

Document history and summary

Chronological listing

Document classification and timelines

Identification of missing records and documents

Pertinent references from medical literature

Medical peer review services help determine if a particular case can be recommended for reimbursement. Reliable medical peer review support service providers also assist attorneys and reviewing physicians prepare for depositions and trials.

If you are an attorney dealing with cases related to general or complex medical issues, contacting a professional service provider will ensure comprehensive and accurate medical peer review support services. Choose your provider with care. Stringent compliance to industry standards, accuracy checks, timely solutions and competitive pricing are features to look for.

by: MOS

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