Medical Record Reviews for Claims & Litigation – Nationwide

Record review

Purpose: Structured, objective chart analysis.
Key Questions: What happened? When? Did care meet standards? Do facts support/refute claims?
Uses: Clinical quality, utilization management, medicolegal (IME, liability, disability).
Goal: Reliable chronology, relevant facts only, clarity without advocacy.

Process

Intake & indexing → clean timeline of encounters, diagnoses, imaging, labs, meds, notes.
Page sourcing for traceability.
Reconcile discrepancies; flag missing records, inconsistencies, pre-existing conditions, alternate causes, gaps, nonadherence.
Compare findings to guidelines/standards.
Record strengths & weaknesses.
Stay within scope: fact vs. interpretation.

Deliverables

Chronology, key findings, numbered conclusions w/ evidence.
Clear limits/assumptions; precise exhibit references.
Respect privacy & chain-of-custody.
Next steps noted (e.g., obtain PT notes, compare imaging, clarify job demands).

Approach

Core skills: careful reading, pattern recognition, clinical judgment.
Enhanced by tools (OCR, timeline software, data extraction).
Conclusions remain anchored in the record.