Medical record reviews serve as the backbone of the healthcare ecosystem, particularly in the intersecting realms of legal matters and insurance. However, medical records review can be expensive, especially in states like California, where Independent Medical Examiners (IMEs) and Qualified Medical Evaluators (QMEs) may charge around $3 per page for their review services. While the review of medical records is inherently a costly process, the expenses can further increase due to duplicate pages within medical records, an issue affecting numerous insurance companies.
In this article, we will explore the significant issue of redundant medical records and how deduplication can be the game-changer that slashes costs while ensuring efficiency in the medical record review process.
Why are Medical Record Reviews becoming costly in California?
In addition to the soaring IME/QME review fees, Medical record reviews in California often come with a hefty price tag due to several other factors. One primary issue is the presence of duplicate pages within the medical records. Medical records are collected from a multitude of sources, and this diverse collection process frequently leads to duplication, resulting in unnecessary repetition. This duplication problem is further exacerbated when both parties involved in a case submit identical records—as happens frequently. As a result, these redundant pages inflate the costs associated with the review process.
The cost of these duplications is not trivial. According to data posted by Daisy Bill on their Blog page, an average of 1,079 pages of records are billed out for medical-legal reports, representing a staggering $3,237 in record review fees by the Qualified Medical Examiner (QME) alone. But here’s the jaw-dropping revelation: at least 40% of these pages are duplicated from multiple sources submitting identical records and reports. It translates to a whopping $1,294.90 in unnecessary expenses paid by insurance companies.
The Deduplication Solution
Deduplication–an economical solution to this costly problem. It is a systematic process designed to identify and eliminate duplicate pages within a set of medical records. It operates on the principle that multiple sources and submissions can inadvertently lead to unnecessary repetition. The deduplication process involves cutting-edge technologies to meticulously sift through the records to pinpoint and remove these duplicates, streamline the review process, and drastically reduce costs.
Let’s break down the steps to understand better how deduplication can be your cost-saving game changer:
- Data Collection: First, gather all the medical records and reports on a specific case. This may include records from medical facilities, healthcare providers, and insurance companies.
- Analysis and Identification: Employ cutting-edge deduplication software to analyze the collected data. The software can identify duplicate pages, ensuring no information is missed or overlooked.
- Data Elimination: Once duplicates are identified, the deduplication software swiftly eliminates the redundant pages, leaving you with a streamlined and coherent set of records.
- Verification: After the elimination process, the deduplication software cross-checks the records to confirm that all duplicates have been removed.
- Report Generation: With the duplicates gone, you’re left with a concise and relevant set of records ready for medical evaluation, legal proceedings, or insurance claims.
Top Benefits of Deduplication:
- Cost savings: Insurers can achieve significant cost savings through deduplication. By eliminating duplicate records, they can reduce unnecessary expenses associated with redundant data. This streamlined data management cuts operational costs and leads to more efficient use of resources.
- Quick turnaround time for reviews: Eliminating duplicate pages from medical records reduces the review burden and enables medical evaluators to conduct accurate evaluations quickly.
- Well-organized and duplicate-free records: With medical records deduplication, insurers can serve IMs/QMEs with well-organized, duplicate-free records for review, making the review process easy and quick.
The PreludeSys Differentiator
The PreludeSys approach to deduplication is a dynamic and hybrid process that combines the power of AI/ML systems with the expertise of experienced reviewers. When you choose to work with PreludeSys, the process begins with uploading both the applicant’s medical records and those of the defendant’s to our secure HIPAA-compliant server and unique file space. Once the records are uploaded, our experts start to work on the system, meticulously tagging the records to identify duplicates. The result is a complete set of deduplicated medical records ready for you to serve on the Qualified Medical Examiner (QME). With our approach, you can rest assured that there will be no duplication of records across both parties’ intended submissions.
To further assist in cost control, we also send you an email with the total page count of records to be reviewed by the QME after deduplication, including pages from applicant side and the defendant’s side. This page count helps ensure that the QME does not overcharge for record reviews in their billing. With the PreludeSys approach, you can streamline the entire process, reduce costs, and improve the efficiency of medical record reviews.
