When you are involved in an accident and suffer injuries, you may bring a civil lawsuit against the party responsible for causing the accident. You may also settle your case outside of court for an agreed-upon sum paid by the person who harmed you. In either case, a medical record review may become necessary to validate that the injuries sustained in the accident and the treatment you received. In addition, a medical billing review may need to be conducted to determine what charges have been incurred. This helps establish the care costs that should be compensated.
The purpose of accident settlements is to make a plaintiff whole again, which means that the plaintiff should receive full compensation for damages: actual medical costs and expenses for injuries sustained. A review of the medical records and bills by trained Legal Nurse Consultants and Billing Auditors can help to bring out all of the pertinent information about the injuries and bills so a plaintiff can get the amount that he deserves. Having your attorney use professional review resources will ensure a fair settlement that will allow you to get back to life as you knew it.
Medical Record Review
A medical record review may be conducted for a number of reasons after a personal injury. Medical record review can also be performed to chart the course of medical treatments and to analyze the types of care being provided as compared with what is normal for a given type of injury.
Medical record review should always be conducted by trained professionals. The details uncovered during medical record review can be used as a negotiating tool with the insurance company or as evidence in a jury trial, so confidence in the results is absolutely essential. Legal nurse consultants are experienced in both the legal and medical fields and are generally the best individuals to conduct this type of review.
Medical Billing Review
Like a medical record review, a medical billing review can be a very important part of a personal injury case and may be conducted for a number of reasons. For instance, a review may be conducted as part of a comprehensive audit of medical bills and treatment. In this case, the purpose of the medical bill review would be to determine whether the services paid for were actually rendered or to determine whether the costs being charged are in line with industry standards. A medical billing review can also compare the cost of services to regional and national average costs or simply calculate the total amount paid in order to determine an appropriate amount of compensation for medical costs.
In many cases, medical billing review also involves separating out unrelated medical charges in order to get a better understanding of where the treatment costs are being incurred. An explanation of benefits can also help to clarify exactly the bottom line of costs. Medical billing review can even help uncover problems such as double charges for services performed.
When working with medical billing review experts, it is important to work with professionals who have experience in the specific field. This may include working with professionals who have both legal experience and experience in medical coding. Both medical billing review experts and medical records review specialists can help in any personal injury case to make sure that justice is done.
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