Physician Record Reviews provide clinical insights through a two-stage retrospective medical record review by certified coders and physicians board-certified in a specific area of expertise. Physicians review records in relation to risk-adjusted conditions, quality and care management opportunities for chronic illnesses in accordance with clinical guidelines.
This powerful insight uncovers the potential for risk-adjusting conditions not identified by routine analytics or coder reviews.
Physician Record Review Process
- A team of physician reviewers identifies evidence within each medical record for risk-adjustable conditions.
- The physician review team identifies areas of lapses in adherence to clinical guidelines for chronic illnesses.
Why are Physician Record Reviews Useful?
- Reviews currently submitted HCCs
- Confirms previous two years of submitted HCCs for clinical confirmation that have not been submitted in the current calendar year
- Identifies new clinically suspected HCCs based on progress notes from primary care, specialists, hospitals, radiology, pharmacy and laboratory results
- Identifies risk factors for clinical interventions for screening of associated chronic illnesses