A Comprehensive report provides an objective expert medical opinion documenting whether or not the treatment rendered was reasonable and the claimed injury(s) was causally related and supported by medical evidence within the documentation. When applicable, the Demand Letter is addressed.
Peer Review Medical records are reviewed by independent and experienced peer physician(s). The retrospective review of the medical treatment focuses on necessity, reasonableness, and relatedness of care. Attention is directed toward analyzing documentation and evaluating treatment:
? Was the treatment medically necessary?
? Was the treatment appropriate and reasonable?
? Was the care rendered causally related to the reported injury/accident?
NOTE: This is NOT a “paper IME”. The Peer Review provides a careful and professional review of the medical documentation to determine the accuracy and appropriateness of the treatment. This is not a subjective review of the patient, but an accurate and documented review of the medical services provided. This can help determine if the diagnosis was proper for the symptoms presented and whether the services provided were proper or even necessary. This provides a significant advantage by focusing not on the patient but on determining and documenting incorrect, improper and/or unnecessary medical services. This can tie directly into a review of medical bills.
Diagnostic Review focuses on the diagnostic procedures. A peer physician will review films, waveforms/graphs (Raw Data) etc., opine the accuracy of the impressions/findings, and discuss procedure protocol. An objective report enables the client to make accurate and informed decisions.
Impairment Rating(s) Review involves an in-depth review of the medical documentation to determine if the Impairment Rating(s) is based on established American Medical Association (AMA) Guidelines. Impairment Rating(s) are a critical component of long-term cost and are incorrectly assigned more than 70% of the time. Our service provides a report to ensure the impairment rating(s) you accept is accurate and error-free.
IME (Independent Medical Examination) are performed by highly qualified physicians who will review medical records and diagnostic studies in addition to performing a detailed, face-to-face medical examination. A comprehensive report will address causal relationship of injury(s), evaluate the injured party’s ability to return to normal activities of daily living/work and discuss the need for future treatment. This service will ensure the client receives an objective opinion to make a fair and informed claim evaluation.
NOTE: The key is to know the exact nature and extent of injury. In order to provide the confidence needed to determine the true nature and value of a claim, it may be necessary to conduct a face-to-face medical examination of the patient.
RDR (Required Documentation Request) entails experienced personnel reviewing the provided medical record documentation, billing and coding. A detailed chart is provided identifying the missing information/documentation assisting the client to effectively and accurately evaluate a claim.