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Third
Party Medical Record Audit
Definition: An audit of a medical file performed by a
professional specific to the discipline of record that
reviews documentation for medical necessity of treatment
appropriateness of treatment, adequacy of service
documentation and progression of recovery culminating in a
comprehensive review document based on scientific based
clinic guidelines and discipline treatment guidelines
resulting in a formal report and table with reference
sources documented.
Features:
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Various chart
review formats available to fulfill your informational needs
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Review disciplines
available: Physical Therapy, Pharmacological, Chiropractic,
nursing
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Services range
from total file review with pertinent questions such as work
relatedness, end of healing, treatment plan issues, or
causation issues
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Option to obtain
specific reviews addressing one issue
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Conducted by certified, licensed,
trained personnel to assure credibility and validity of
audit
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Service may
encompass all or a selection of the following:
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Standard/complex
medical chart review
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Initial care review (nurse)
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Chronological
review
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Red flag summary
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Chiropractic dates
of treatment summary
Benefits:
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Customizable
service and reporting
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Identifies need
for independent medial evaluation, functional capacity
examination and utilization review at the appropriate time
to impact the case
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Valid and
defensible documentation of recommendations
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May be combined
with Third Party Medical Bill Audit (see #6)
Cost: Hourly rate agreed mutually agreed upon.
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REFERRAL FORM
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