​

Chapter 1

The Industry of Medical Record Review

• What is a Medical Record Collector?

• What’s In a Medical Record

• Healthcare Providers

• Electronic Medical/Health Records (EMR)/(HER)

• Introduction to Medical Informatic

• Types of Chart Reviews

• What is Utilization Management or Utilization Review

​​

Chapter 2

Patient’s Rights & Insurance Products

• Health Insurance Portability & Accountability Act (HIPAA)

• What is PHI?

• Health Maintenance Organization (HMO)

• Medicare

• Medicaid

• Tricare

• Health Care Reform Bill

​​

Chapter 3

Quality of Care Initiative

• Introduction to NCQA

• Center for Medicare & Medicaid Services (CMS) STAR Ratings?

• How is HEDIS® Data Used?

• Components of HEDIS®

• Data Collections Methods

 

Chapter 4

How to Collect Records for Hybrid STAR Project

• Medical Records Retrieval Process for STARS Hybrid Project

• Sample Medical Request Letter

• Chart Pull List

• On-Site Visits

• How to Prepare for a Site Visit

• HEDIS® Call Script?

• What is a Chart Chase?

• Receiving Medical Records For STAR Ratings Project

​

Chapter 5

How to Collect Medical Records for Legal Purposes

• Requesting Medical Records For Legal Purposes

• The Fundamentals

• Requesting Medical Records From a Doctor

• Special Rules for Hospitals

• Wrongful Death

• What Is The Fastest Way To Request Medical Records?

• Should Medical Record Collectors Put The Doctor's Name Or The Name Of Their Practice On The HIPAA Authorization Form?

​

Chapter 6

• Copy Service / Third Party Vendors

 

Chapter 7

• Telephone Voice Etiquette Techniques & Best Practices