Why Medical Record Retrieval Is Important for the Insurance Industry


Why is medical record retrieval important for the insurance industry that is usually more focused on claims review? An insurance policy may be associated with long-term care, disability, life or health. Whatever the nature of the policy may be, record retrieval services have a major role to play. These services support insurance claims agents by compiling a comprehensive health history of the concerned person so that the insurance company can take a proper payment decision on the basis of the medical records retrieved. In addition, payers can save costs associated with using in-house resources for requesting, tracking and managing the records.

Efficient Requesting, Tracking and Receiving of Medical Records

Medical record review companies offering this service follow efficient and proven retrieval methods that are designed to suit the needs of payers. To decide on the best approach, they carefully scrutinize factors such as provider distribution, patient demographics, turnaround time, and IT infrastructure among others. Apart from receiving the records via mail or fax, some service providers use onsite scanning along with remote access to EMRs and mailed/faxed records. Most importantly, maximum security is offered for the valuable healthcare documents.

Why Outsource?

  • Reduce the burden of in-house management of the retrieval process, and reduce overall costs. Naturally, this allows your office staff to spend more time on core business processes.

  • Many retrieval companies offer an additional audit function. Medical records release is regulated by state laws that also provide for standardized copy fees and service charges. In-house records custodians are often not aware of these laws and end up charging higher than the amounts stipulated by law. Incurring such extra charges can be avoided if the records retrieval is outsourced to a company that is knowledgeable in this regard.

  • A dedicated outsourcing partner would ensure that you have all the medical information available to make a proper decision. Plaintiffs often may not disclose previous injuries or treatments undergone that could have a negative impact on their settlement. Reliable medical chart retrieval services would ensure that all vital information, even unrevealed details are made available.

  • A record retrieval company will secure records faster than organizations performing this task in-house. This is because they focus their resources, attention and efforts on developing techniques to obtain the records faster. They frequently check the status of medical record requests with custodians.

  • Some outsourcing providers also create and service subpoenas in all states. This helps insurers eliminate the need to understand varying legal requirements for records retrieval in different states and jurisdictions.

  • Now, HIPAA Omnibus rulings have put specific responsibilities on the process of monitoring who has access to PHI or protected health information. Payers need to ensure that a record and written policy is in place, which outlines the rules of gaining access to the medical records. With a professional firm to take care of record retrieval, payers need not make a record of each person involved in the request, follow-up and delivery of the medical documents. This will help minimize non-compliance and associated penalties.

  • Insurers get to enjoy lowered costs of claim payments and potential claim litigation because they receive a complete medical history of the insured person and can avoid inappropriate payments.

  • The entire healthcare records retrieval process becomes easier and faster. The record retrieval company would provide customized activity reports, and information regarding missing records. All records are made available within the required turnaround time.

Choosing the Right Medical Record Retrieval Company

  • Ensure that the outsourcing service provider has a good reputation and can help you achieve your goals.

  • A company that can offer fast turnaround is the ideal partner.

  • If your provider has an online web-based system for ordering records, it is best. It should be possible to deliver and manage the records including storage and backup via the web-based interface.

  • A provider that can serve you round the clock is the best choice.

  • The commencement of the records requests should be quick and easy, with provision for status tracking.

  • Ideally, there should be a dedicated account manager to take care of your account during your normal business hours. This person must be able to quickly respond to your questions and address any concerns / problems.

  • Choose a provider who has a vast network and capability to quickly retrieve records from medical providers across the U.S, and overseas if necessary.

Copyright © 2016 Jan Merrifield, All rights reserved. No portion of this article may be reproduced without the express written permission of the copyright holder. If you use a quotation, excerpt or paraphrase of this article, except as otherwise authorized in writing by the author of the article you must cite this article as a source for your work and include a link back to the original article from any online materials that incorporate or are derived from the content of this article.

This article was last reviewed or amended on Oct 11, 2016.