Avoiding Rabbit Holes in Medical Record Review

It's so easy to get caught going down a rabbit hole when performing medical record reviews. In this video, we take a moment to check in with one of our medical review experts, Terri Riis-Christensen, CPC who shares an important strategy that she uses when completing medical record reviews to avoid wasting time.

Terri Riis-Christensen has over 25 years of experience reviewing medical records. In the latest in our Integrity Advantage Learning Series, Relating to the Reviewer, Terri speaks candidly about the trap that medical record reviewers sometimes fall into when working on a case.

It is important to do critical research when working on a new case but be careful! Have you ever found yourself going down internet rabbit holes trying to find a reference, a code, a process, rules/regulations, a denial reason or a further understand the procedure being questioned? How far do we go down rabbit holes when looking for denial reasons? Terri offers some things to consider when doing research:

• Are you researching to understand the procedure in the report?

• Is your search efficient and a good use of your time?

• Does what I see in the record warrant research beyond the CPT description?

• If so, will going to an association, academy or college be easier than just a Google search?

• If reading an article, will clicking the link (or many links!) provide pertinent information related to the case?

• Is the information I’m learning nice to know, but not relevant to the case or determinations?

• To what end will the denial make a difference?

• Can the item be listed as an education point.

We are reviewing for fraud, but we see more waste, and abuse. As a reviewer, we don’t have to add to the waste by spending more time than necessary on something that can be a one-off.