Avoiding Rabbit Holes in Medical Record Review
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.
Hello, I’m Terri with Integrity Advantage, and I wanted to share my thoughts on something that came to me while working one day. I’m sure we’ve all had times when we were researching a case, whether it was looking for rules or trying to understand a code or a process, and it seems like we were taking more time than it should. How do we know that the time we spend is valuable versus just going down the rabbit hole?
This happened to me not too long ago. I was researching a procedure I was not familiar with, and I kept clicking links and reading articles, and then I would question something from the article and research that new tidbit. And I finally had to stop myself and say, I don’t need to know how to perform the procedure. I just need to understand what I’m looking at in the report.
Well, we want to make sure we research to create the best possible review, we also need to be efficient. I decided going forward to ask myself: does what I see in the record warrant research beyond the CPT description? If it does, will going to an association, academy, or a college be easier than just a quick Google search. When I’m reading an article, will clicking the link (or the many links) in the article provide me with pertinent information, or is it something extra that would be nice to learn about but not necessary for the review at hand? I think at times if we stop and ask ourselves questions, we might save ourselves from going down rabbit holes, yet still gain the insight we need to work the case.
Another thought is: how far do we go down a rabbit hole when we’re looking for a denial reason? I started my career in healthcare in 1995. I’ve learned so many rules that are stuck in my head, but when it comes to a denial, I’m adamant about a resource. I have spent hours looking for resources to back up what I’ve learned, to no avail. I’ve since learned to look at the review and determine: to what end will this denial make a difference? If it’s something minor, do I need to spend that much time, or can I just list it as an education point? We are reviewing for fraud, but in my experience, we see more waste and abuse. I don’t need to add to the waste by spending more time than necessary on what could be a one off. Have a good day!
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