Hospital Peer Review

Hospital Peer Review

Hospital Peer Review

Hospital peer review is a key component in the analysis of hospital operations.

In the case of medical records audits for hospital procedures, each review checks to make sure that the hospital billing for services reflects the correct diagnosis related group which is the overall category that is used to qualify the billing of the procedures for correct reimbursement. In order to achieve this, it requires an in-depth analysis of the patient's medical records that validates the proper procedures and their correct codes. In addition to this method of checking the code validation against the procedure, it is also necessary to complete an in-depth medical review of the patient record in order to be certain that the case has been dealt with properly in the correct sequence with the know protocols for disease management. No only will this medical record review identified the proper code for billing but it will also identify the maximum allowable coded for particular procedure as billed in the most effective way according to the medical condition.

The coding audits need to be provided by qualified practitioners. With formal ICD-9 and DRG coding training and credentials. Hey should be Registered Health Information Technicians and Certified Coding Specialists with at least five years experience in coding for hospital procedures and hospital stays.

Special internal and external audits can be conducted of the medical records that are need to cover all the proper specialties in order to have accurate results that are the most relevant and obtain the highest statistical value for the client. Project objectives are designed in such a way that the claims information , health research and analysis are applied to the medical records review process so that the professional resources are applied as a team effort in the most effective and efficient ways possible.

Hospital peer review provides the accurate data and the professional analysis as required for certification and compliance issues as well as tracks and improves the quality of care issues that are so critical in providing quality hospital care.

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