Physician Record Reviews

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