No Assumptions on Allegations

In the third video of our series, Relating to the Reviewer, Terri Riis-Christensen tackles another important topic: not going into a review with preconceived notions or assumptions.

When you receive a new case, set your mind to the task at hand.

As a medical reviewer, we sometimes can be prone to reviewing the same type of allegation.

It’s important not to start a case with preconceived notions based on previous similar cases.

We need to start at the beginning with setting up our case, reviewing the allegation and what is my focus for the case:

• Is the allegation completely different than previous cases?

• Are there documentation issues unique to this case?

• Can a pivot table and data provided give some insight before reviewing the case?

• Is the allegation pointing to something that I’m not familiar with?

• Do I need to do some research before jumping into the case?

To be efficient, effective, and unbiased, treat each case as new and leave all assumptions at the door.