Medical Record Review

A BHS Medical Record Review may be performed as a Stand-alone Service or as part of a Practice Analysis. This review encompasses the entire claim submission process, from patient demographics through payment resolution. The sample of medical records to be reviewed may be composed of paid claims or, if preferred, pre-billed claims (which allows identification of potential billing errors before claims have been billed and paid). We recommend that a Focused Medical Review be considered as well so that a more accurate identification of potential coding aberrancies in the paid claims through peer comparison.

The BHS record review deliverable includes a comprehensive report with exhibits, including spreadsheets sorted by patient, CPT code, group physicians and sites (when multiple). Other exhibits include educational reference material as appropriate, such as Carrier Bulletins, CMS(previously HCFA) Policy, and Code of Federal Regulations and/or Federal Register articles, etc.