If you own a law firm or you regularly deal with insurance claims, knowing how to order, manage, and optimize medical records and their retrieval is crucial. One of the most major difficulties in these caseloads is poor or insufficient medical documentation, which can result in a host of complications for attorneys who are trying to help their clients achieve success in their legal cases.
It should come as no surprise that delays or denials in acquiring medical data can have devastating consequences. For this reason, it is vital for legal teams to understand the medical record retrieval procedure and how to handle it efficiently.
The Workers’ Compensation Process
Once an injury has happened and been reported to the corporation that provides the coverage, a worker’s compensation insurance adjuster has only two weeks to decide whether to pay or deny a claim.
An adjuster’s decision is based on the information included in medical papers, and if the claim is denied, a formal lawsuit is initiated against the employer. Legal specialists in these types of disputes must be familiar with the intricacies of medical data in order to identify critical areas that could affect the outcome of a case.
The Importance of Medical Records in Workers’ Compensation
Before accepting or denying a workers’ compensation claim, insurance companies rigorously examine all available information. The insurer will suspect fraud if there are discrepancies between the report your client filed at work and the medical data they provided.
Furthermore, if your client was taken to the emergency room (ER) after a work-related injury and ER records show that he or she was under the influence of illegal narcotics, the insurer may deny the claim.
Medical records are used to establish whether or not a particular operation or therapy is medically necessary and hence covered by workers’ compensation insurance. Medical documents for your client are especially important because they indicate whether or not your client has any pre-existing health issues. Workers’ compensation insurance in the majority of US states covers only the worsening of an employee’s physical condition as a result of a work-related injury or sickness, not pre-existing conditions.
If a claimant has a pre-existing condition that is medically related to their claim, their payment will almost probably be decreased. Pre-existing medical conditions may exacerbate or contribute to work-related accidents or diseases. Furthermore, these diseases may inhibit or delay recovery. In such circumstances, the insurance may refuse to reimburse portion of the therapy costs.
While it is reasonable that some people may prefer not to mention pre-existing conditions on their insurance applications, doing so is not recommended.
Why is Medical Record Retrieval For Law Firms Crucial?
Medical records retrieval is not an easy procedure. HIPAA requirements must be followed, which makes acquiring documents from healthcare providers difficult. While going through the process, it is important to understand what type of medical record is required and what information should be included. The technique is time-consuming and inconvenient. You are highly prone to make an error if you are inexperienced with the steps required to retrieve the records and are not aware about the process. This is why you need skilled medical record retrieval support specialists like those of ITCube BPM who can handle this for you quickly and efficiently.
Medical record retrieval is a time-consuming process that requires the requesting party to understand exactly what they are looking for and where to look for it. To begin with, written or typed notes prepared and signed by a physician are frequently on the list of prerequisites. A worker’s chart with handwritten notes could be useful in a worker’s compensation dispute. However, it is typically the doctor’s treatment notes, which are dictated and transcribed following an examination, that serve to develop a worker’s compensation case.
Medical records retrieval processes should be in place in all legal offices, but they should be especially so in worker’s compensation cases. While some law firms prefer to handle medical record retrieval in-house, many others prefer to outsource the service due to the numerous benefits of dealing with a specialised supplier.
It is not just that legal support services that help with medical record retrieval are cognizant of the meticulous and time-sensitive nature of recovering vital data, but they have also formed relationships with providers and record custodians, which allows them to drastically speed up the retrieval process. Please review the following list of the most important reasons why your law firm wants competent medical record retrieval services:
The ability to outsource medical record retrieval services because your legal staff is overburdened or just to have a more dedicated set of hands working on your behalf is a viable alternative for law firms all over the country.