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.
Hi, it’s me again, Terri, a medical reviewer with Integrity Advantage. I just wanted to talk today a little bit about setting our minds to the task at hand. As a reviewer, we can be prone to reviewing the same type of allegations. And so we get into the habit of knowing what we’re going to do right at the beginning. But, sometimes the allegation might be a little different.
Example: I just had one (and that’s what made me think about this topic) where the allegation didn’t ask me to review anything at all. I mean, of course, I did go ahead and do a complete review of the documentation and I looked at what other changes or what other issues there might have been, but the allegation really just required me to look at data.
And so in that case, my favorite thing, (I love to do pivot tables), I was able to input information in a pivot table and come out with the answer before I even started reviewing the case. So, I think sometimes we need to start from the beginning with setting up our case and not just assume everything is going to be the same and jump right in. We need to go ahead and say: what is the allegation, what can I do, do I need to do a little research first because I don’t know anything about it, or is it just a regular E/M review or surgical review of some sort that we might be used to.
Just something I thought about & wanted to say. Bye!
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