Accurate documentation lies at the heart of any successfully administered insurance claim. A well-managed reporting function brings together critical information on interrelated case details, communicated damages, feedback from professional assessments, as well as dates and times for specific verification procedures.
For insurance providers, patient records offer all the supporting evidence required for an accurate claims assessment, without the need for additional IMEs. At Ochotech Solutions, our team of experienced medical reviewers is available to support and streamline the peer review process in a variety of healthcare circumstances.
Whether you’re evaluating the appropriateness of treatment provided after a medical malpractice case, a mass tort issue or a personal injury claim we can help to prepare, edit and organize documentation to enable the judgments made by your attorneys and reviewing physicians.
Whether you’re delivering critical medical opinions or making key decisions about patient care, there are a variety of risks that you need to avoid. From non-compliant documentation to lack of niche expertise, legal understanding or a perceived deficiency in quality of care you need to take steps to protect your reputation and accreditation.
At Ochotech Solutions our reviewers have years of experience working with the specific medical and legal considerations of insurance and healthcare providers in New York. Our experts can identify the key clinical events in a patient’s medical records and piece together a cohesive analysis that is well-formatted and compliant with HIPPA/OPPE/FPPE regulations. Depending on the specific details of your case we will match you with appropriate board-certified medico-legal professionals that can ensure a speedy, effective evaluation of the key details of your case. From there, we work with transcriptionists and medical coders to deliver criteria-based ratings, evidence-based findings, clear metrics, and a rundown of the performance issues and risks which could affect decision-making. We also offer extensive post-review support including specific guidance on reports and strategic recommendations on your next steps forward.
We work to ensure that your peer review reports are:
In this way, we can ensure that your assessment team has all the documentation at hand to deliver a timely, adequate and complete decision on the validity of the patient’s claim. Our medical reviewers bring extensive expertise in medical and legal domains to the table and combine these multi-disciplinary skills with industry-leading infrastructure. As a result, we are able to help you assure that:
Ultimately our goal is to make sure that whenever a claim is rejected on the basis of a medical review report, that the findings are able to stand up to any medical or legal scrutiny which follows.
We can also help insurance providers avoid minimize the possibility of overstated or miscalculated reimbursements. Our bill reviewers will perform an in-depth analysis of treatment rendered according and compare the relevance and cost against acceptable standards of care. This comprehensive analysis can often reveal discrepancies that even sophisticated systems struggle to pick up. We will also assess medical coding to determine whether any incidences of fraud, up-coding or under-coding are evident in the documentation.