subject: Medical Chart Reviews [print this page] In order to provide an adequate medical chart review it is necessary to take in to account the comprehensive factors involved in medical records reviews.
These medical chart reviews are focused on identification of the problems that may occur. These troubles may show up in the pre-certification process, the review process or in the quality of health care. They are identified through a number of methods including analysis of consumer complaints, trend and pattern analysis, legislative compliance, discrepancies, and a range of issues surrounding the program integrity. These focused reviews may result in a provider resubmitting a significant amount of claims where the codes have been upgraded based on comparison of the medical record within the claims data. Another item that is discovered in these reviews is the analysis of the transfer practices where the patient is shifted from one level of care to another level of care. The methods used for the reviews are chosen to benefit the organization especially in the areas of utilization of services. Analysis is made of all management practices in comparison with reviews of physician treatment protocols, institutional regulations and the type of provider involved.
Reviews can be custom designed to target specific of data analysis and organized according to sample size and data targets. Review determinations will be based on the appropriate sizing and scope of the process necessary to create an adequate and significant result.
In order to improve the value of ongoing health care, it is important to conduct quality assessments on a regular basis.
This helps to not only improve the quality of health care provided but also aides in reducing wastes, and lowering costs by providing the correct access to the proper health care for the beneficiary in the most efficient manner possible. Sometimes there is a need for specific issues to be examined and problems to be addressed that can be coordinated in a collaborative effort with your own quality review team. Specifically defined patient groups can be examined to determine the outcomes of treatment protocols and their total clinical result. This works for any type of care that is provided whether it is managed care or fee-for-service care. Individual patients re surveyed as a sample set, to compare against the control groups. From the results of the reviews the improvement efforts recommendation may be implemented and also tracked by follow up medical record reviews to create the correct atmosphere and response rates for improvement as part of a fine quality review.
Medical chart reviews are the paramount of quality assurance and be to be conducted with the highest level of adherence to policies and procedures.
