Why Do Insurers Need Medical Record Review? [Infographic]

Premiums of the healthcare coverage may vary based on the health conditions of the applicant. Accurate review of medical records is important for insurance companies to help them ensure a fair claim settlement in personal injury, medical malpractice and other medical litigation. Insurance medical record review must be accurate for the insurers to prove fairness, medical necessity, fraud, embellishment, and up-coding among other aspects.

The medical review process involves a detailed analysis of the medical records of the claimant – admission notes, physicians’ notes, nursing notes, correspondence between healthcare providers, diagnostic tests, monitoring equipment printouts and so on. As insurance investigators and claim handlers may not be familiar with the complex medical jargon, it is ideal for insurers to consider the support of an experienced medical record review company. Reliable companies provide the service of experienced professionals who have good knowledge in organizing, interpreting, analyzing, and summarizing medical records.

Insurance defense attorneys also require proper review of medical records, as they have to work with insurance companies and their insured parties and insurance service organizations to provide comprehensive, efficient, and aggressive litigation services. They may have to deal with cases ranging from pre-suit investigation through the appeals process.

This medical history could have an impact on the claimant’s insurance costs, which is often revealed through a comprehensive review of his/her medical records.

Check out the infographic below