Outsourcing vs. in-house medical record review services, confused on how to proceed with the medical record reviewing? Follow me till the end and I am sure you will say “Yes, now I know what to do”.

Before digging deep into this topic, we will quickly have a look at what does the term ‘medical record’ refer to. Let us presume that that an individual is encountering a car accident and getting injured. Obviously, he would seek medical attention during which a medical chart would be generated. Let us see what type of data the medical record would reflect.

  • Demographic data
  • Location of injury, signs of fracture if any
  • Previous medical history
  • Preliminary diagnosis of the physician
  • Diagnostic tests suggested by the physician
  • Medication if prescribed
  • Details of surgical procedures if any

In short, a medical record is the documented storehouse of an individual’s clinical data which serve as evidence of his medical encounters. It is considered as the actual plot of a story because we claim compensation for the injuries caused to us by an at-fault person or a business. Medical charts act as crucial evidence. They determine the success of a legal battle involving injuries and damages of the claimant.

Can medical charts be used as such in a lawsuit?

No. Medical records are hulking with the whole medical history of the claimant. Filing a lawsuit does not require the entire data present in the medical chart. For instance, if it is a car accident claim, the medical data required would be only the injuries and illness pertaining to the accident. Yeah, under some circumstances medical encounters on some pre-existing conditions may also be required.

How is the relevant medical data filtered out?

Medical record review and analysis is a process that filters out and scrutinizes the relevant clinical data from the entire medical database of the claimant. Let me make it clearer to you. If I plan to claim compensation or insurance for a personal injury, my medical record would be the first line of evidence. For the claiming process, the lengthy medical record would be reviewed and converted into an easily accessible form.

You will understand more about the process as you read further.

Importance of Medical Records Review:

Medical records review and analysis is very crucial in medico-legal cases like personal injury, medical malpractice, mass tort and worker’s compensation. They act as solid evidence for the Attorneys and paralegals to substantiate insurance claims. Health care sectors also utilize medical chart reviewing for providing better services and ensure patient safety. We will be discussing more on medical record review services used by attorneys.

How Medical Record Reviewing is Done?

‘Medical chart review.’ Sounds very simple right? Can’t blame you for that. But the process is not an easy one unless it is done by professionals and experts with a medical background. Let’s grasp the stages of medical chart review in simple steps.

  1. Collection of medical records
  2. Organizing the reports and collecting the misplaced records if any
  3. Detailed study of the clinical findings in the report
  4. Clarification with the concerned physician for any doubts
  5. Preparation of the report with chronology

How does a law firm review medical records? How do they know the importance of treatments, diagnosis tests, and medications?

Reviewing medical records could be carried out by in-house medical chart reviewing or the process could be outsourced to a company that offers medical record review services. Let’s see how the process is classified.

1. In-House Medical Record Reviewing

The reviewing process is carried out by the legal firm itself without depending upon any external agency for the medical record review services. The attorney would have his own team and they carry out the review process along with other usual services.

2. Outsourcing Medical Record Review Services to Companies

Medical chart reviewing would be offshored to medical record review outsourcing companies. These external agencies carry out the process and submit the final document to the legal firm. The report is called medical record review report.

Medical Record Review Services: In-house vs. Outsourcing

Let us now do an in-depth comparison between in-house reviewing vs. offshoring medical record review services.

1. Cost of the Medical Record Reviewing Process

Legal firms opting for in-house training have two possible options. Either they should provide training to the existing team to conduct medical record reviews or they should hire professionals for the medical chart reviewing process. The workload won’t be the same throughout the year but the in-house paralegal team must be paid irrespective of the workflow.

The expense to outsource the medical review services will be less when compared to that. Moreover, outsourcing expense will be based on medical records to be reviewed rather than paying the legal team as a fixed, monthly salary.

Reputed medical records outsourcing companies offer comfortable billing cycle and convenient payment methods. Hourly pricing, and per-page pricing would be offered as per the requirement of the client. Best pricing with easy payment options would make the medical record review process a smooth sail for the attorney.

2. The Expertise of the Medical Record Reviewer

Preparing medical narrative summaries and medical chronology demands in-depth medical knowledge. The paralegals and the staffs in a legal firm would definitely be able to analyse the medical data. However, to understand the intricacies of the injuries and their future setbacks would be needed in medical record reviewing which may hurdle the in-house reviewing process.

When the medical chart review process is outsourced to a reputed medical chart review outsourcing company, the review would be carried out by experts in the field. External agencies would have a dedicated team of doctors, paramedical professionals, legal nurse consultants, data analysts and case managers. A medical chart review done by a skilled and qualified medical records reviewer would reflect in the quality of the final report.

A qualified medical chart reviewer would easily comprehend the needs of the client. They would easily identify the strengths and weaknesses of the claim from the medical charts. Identifying the missing medical charts is never hard for them.

3. Accuracy and Precision of the Medical Chart Reviews

It is not necessary that the attorney or his team should be familiar with complicated medical terminologies and all the clinical details to be highlighted in the medical record review. Accuracy and precision will always be an advantage in outsourced medical reviews. Handwritten medical charts or prescription notes, companies offering medical record review services would dissect the records in no time. Medical terms are familiar for a professional medical record review expert and he would crack them easily. The following add-on services would be icing on the cake while outsourcing a medical records review.

  • Hotlinks/hyperlinks
  • PDF sorting and indexing
  • MED-A-Word
  • Missing record identification
  • Medical Synopsis
  • Treatment timeline
  • Pain medication chart
  • Pain and suffering chart

Medical chronology services, deposition summary services, demand letters and medical narrative summary services, everything under a roof would help the attorneys save time and effort.

4. Turn Around Time to Review Medical records

Time is precious and when it is about a legal proceeding, each second is hefty. The time required by an outsourcing company for the medical record review services is referred Turnaround Time (TAT).

Less TAT doesn’t mean a compromise in the quality of the services offered. A reputed company would offer multi-level audits of their reports within a short TAT. They also offer expedited services for high- priority files.

It is quite obvious that the legal team cannot spend their work time completely for the review of medical records. They will have other litigation services also to work on. Now you can compare the work speed of a legal team and an outsourcing company offering medical record review services. A law firm would find it hard to prepare medical chart reviews in a very short time when compared to outsourcing companies. This may delay the trial preparation.

5. Data Security of the Medical Record Review process

My medical record is my privacy. Data security is an important concern when it comes to medical data of an individual. Offshoring the medical record of an individual to a third party is a risky affair as the records are highly confidential with private data.

Now you may think how data security could be assured while offshoring medical record review services.

A competent medical chart review outsourcing company would have policies and standards in place to maintain integrity of the data shared with them. They would have secure remote access, PC locking, secure premises login, confidentiality and non-disclosure agreements to maintain the confidentiality of the medical charts they receive. The common data security standard of a company involved in medical record review outsourcing is Health Insurance Portability and Accountability Act (HIIPA).

A professional medical record review expert would be trained to maintain data security. Overall, the company maintains a secure work environment with robust data handling technologies that would maintain the confidentiality of the medical charts.

Maintaining a data secure work environment and training the staff would be an expensive affair when the attorney does in-house reviewing of the medical charts. That would demand more infrastructure and other facilities to handle the process.

Final Thoughts

With this detailed evaluation, I hope you are clear that outsourcing medical record review services will always be the unsurpassed choice for reviewing medical charts. It is not just a trend but a need. When medical record reviews are imperative in medico-legal claims, choice of the medical record review services could turn the game upside down.

Outsourcing medical record review services would be one of the pragmatic picks by an attorney and it could definitely determine the fate of the claim and the compensation awarded to the claimant. The company should have a consistent and efficient track record with good client testimonials. It will be an advantage if the organization is proficient in versatile litigation aspects like personal injury, mass tort, worker’s compensation and medical malpractice.

A successful claim depends upon how the evidence is unearthed and damages sustained by the claimant are presented. It won’t be hard for a battle-scarred attorney with a customized medical record review report. A well-built claim with a precise medical record review and analysis would be an added asset to an exceptionally skilled attorney to substantiate his arguments. It would be a smart choice to offshore the headache of medical chart reviewing to experienced hands. This would save the time and productivity of the legal team. Cherry-picking a professed medical record review outsourcing company would make the job breezy.

‘Look for your choices, pick the best one, then go with it’.