Chapter 1
The Industry of Medical Record Review
- The Role of a Medical Record Reviewer
- What’s In a Medical Record
- Healthcare Providers
- Electronic Medical/Health Records (EMR)/(EHR)
- Introduction to Medical Informatic
- Types of Chart Reviews
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
Chart Review for Legal Purposes
- How to Collect Medical Records for Legal Purposes
- What is a Legal Document Review?
- How to Review and Summarize Medical Records in Personal Injury Cases
- Sample Record Review for Legal Purposes
- Scenario 1
- Scenario 2
Chapter 4
Risk Adjustment Models for Coding – Chronic Diseases
- What is Risk Adjustment?
- What is Chronic Illness and Disability (CDPS) Model
- What is Hierarchical Condition Category (HCC) Model
- Sample Record Review for Risk Adjustment Coding
Chapter 5
Employee Benefits and Disability Claims Review
- Employee Benefits and Disability Claim
- Sample Review for Disability Claim
Chapter 6
Utilization Review
- What is Utilization Management and Utilization Review
- Sample Record Review for Utilization Review
Chapter 7
Quality of Care Initiative
- Introduction to NCQA
- Center for Medicare & Medicaid Services (CMS) STAR Ratings
- How is HEDIS® Data Used?
- Components of HEDIS®
- Data Collection Methods
- Cervical Cancer
- STAR Hybrid Sample Record
Chapter 8
How to Request Medical Records
- Telephone Voice Etiquette Techniques & Best Practices
- On-Site Visits
- Chart Pull List
- What is a Call Script?
- What is a Chart Chase?
- Receiving Medical Records for STAR Ratings Project
