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Medical File Audit – Nurse

ICS Medical File Reviews are utilized to assist in evaluating cases with a focus on assessing causation, impariment, and approprriateness of care.

Medical File Reviews are a concise, accurate analysis of either a specific medically related issue in a claim file or the thorough and comprehensive review of the medical records associated with a claim file.  Medical File Reviews are utilized to assist in evaluating cases. Usually the focus of a medical file review is to assess causation, impairment, and appropriateness of care

The ICS Medical File Review provides the carrier, the adjuster, or defense counsel with a comprehensive expert review of medical records, identity providers and missing records, provide a detailed timeline of events cross-referenced with organized medical records, analyze injuries and pre-existing issues and determine what aspects of the case require your focus and attention.

The ICS Medical File Review is a valuable reference tool for the evaluation of claims and accurate reserving. During negotiations it gives the adjuster a quick summary of the medical records to refer to while speaking with attorneys.    The reviewing nurse acts as a medical resource for the carrier, adjuster or attorney. The nurse can make the appropriate recommendations for referrals to medical experts when indicated. A nurse acting in this role has a broad knowledge of a variety medical subjects and clinical experience with traumatic injuries.

The output report generated as an outcome of the Medical File Review will provide the carrier, the adjuster, or defense counsel with a comprehensive expert review of medical records, identify providers and missing records, provide a detailed timeline of events cross-referenced with organized medical records, analyze injuries and pre-existing issues and determine what aspects of the case require your focus and attention.  Medical File Review service overview include the following:

• We accept the records in hard copy format, electronic upload or on CD-ROM.
• Chronological summary of the medical treatment
• Review of any prior injuries or pre-existing medical conditions
• Explanation and definition of medical terminology and treatment
• Outline of future treatment and/or related impairment
• Commentary on the causal relationship of diagnoses and or treatment to the loss
• Suggestions for additional investigation
• Recommendations for independent medical examinations and/or reviews
• Summary of the report and opinion
• Mitigating factors
• Questions that may be used for depositions or trial
• Medical literature citations when indicated
• Illustrations and demonstrations for trial presentations

Demand Package Review – Third Pary Audit & Analysis

ICS’ Third-Party Audit and Analysis solution provides a combination of Bill Review, Code Review, and Nurse Review in one complete comprehensive report.  Our Demand Package Management includes:

• Our technology automates the application of rules for a consistent and efficient review
• The Medical Bill Review audit is always completed using Certified Coders which assists in determining the appropriate fees and procedure codes
• The Professional Nurse Review audit process provides a comprehensive understanding of the injuries presented, the treatment involved, and the recommendation as to the appropriateness and relatedness of the charges
• Our technology automates the application of rules for a consistent and efficient review
• The Medical Bill Review audit is always completed using Certified Coders which assists in determining the appropriate fees and procedure codes
• The Professional Nurse Review audit process provides a comprehensive understanding of the injuries presented, the treatment involved, and the recommendation as to the appropriateness and relatedness of the charges

Given the varying needs tied to a Third Party Audit & Analysis, ICS has created a four tier service model with corresponding pricing to support this line of business.