What are the Key Features of a Reliable Peer Review?

What are the Key Features of a Reliable Peer Review?

Peer review is conducted when review of the medical records is not enough to convince the insurer that the claim is genuine.

Any confusion associated with medical claims can be avoided if medical review companies provide a well-prepared peer review report that makes all medical aspects clear for the attorneys, insurers and claimants. This review is conducted mainly to decide whether the medical services provided by the treating physician were medically necessary.

Consider an imaging service that the patient has had for which he/she has claimed insurance reimbursement. Once the claim is sent to the insurer accompanied by relevant documents and medical evidence, the insurer may call for a re-verification via a radiology peer review to ensure the claim is genuine. For this, the imaging records and other relevant medical documentation will www.mosmedicalrecordreview.com

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be sent to the medical peer physician. After reviewing the records, the physician will prepare answers to the insurer’s questions.

Key features of a reliable peer review 

The review will be complete and unambiguous

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All the questions posed by the insurer will be answered

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There will be no ambiguity whatsoever in the answers provided

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There will be no unanswered questions, so that nothing is left unsaid

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There will be no unnecessary elaborations or answers

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All details regarding the treatments and other medical procedures will be clearly listed

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The report will demonstrate the legal and medical knowledge of the reviewer

Reviews act as a helpful legal document whether for claim denial or acceptance. Most insurers and attorneys prefer associating with a company providing accurate medical review solutions rather than partnering with an individual physician. Such companies will have expert reviewers to prepare the review report and the final report will go through multiple verification checks by experts to ensure accuracy and clarity. A negative review by the peer review physician could lead to claim denial and the claimant may seek legal counsel. In that case, the insurer will have to support their denial decision with appropriate medical peer review report containing the actual reasons for the claim denial.

www.mosmedicalrecordreview.com

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