Business Process Services

The Significance of Lab Reports in Medical Record Reviews

11 April 2022

A Healthy Life

Being healthy is a state of mind; health involves both physical and mental wellbeing. Many factors play a role in a person’s health, such as gender, age, race, and hereditary medical conditions.

Numbers and Values

Lifestyle diseases such as diabetes, in people without a family history, develop slowly (pre-diabetes) and often go unnoticed for several months without any symptoms.  In such cases, patients need regular visits to the laboratory to keep track of their sugar values.  The lab tests performed at regular intervals result in a significant increase in the volume of the medical records of the patients.

About 60% to 70% of all diagnoses are made based on laboratory tests, a significant number in healthcare.

Review of Lab Reports

The laboratory tests are helpful in the early detection, diagnosis, and prevention of various disease conditions. Physicians believe even certain types of cancers are curable if detected early.

Review of laboratory reports plays a significant role in the job of a medical records reviewer.  The laboratory reports are marked for special attention in medical record indexing at the beginning of the medical record review process.  The reviewer follows a specific format while summarizing the lab reports and makes sure he or she does not miss an important result from the lab test.

Review of Screening Tests

When it comes to reviewing the screening tests such as urinalysis, when the urine is clear, it is a normal value, but when there is a change in color, such as red, it could be a sign of urinary infection or even cancer (hematuria – blood in the urine) and must be included in the report.

A urine drug screen (UTOX) can assist physicians in determining the status of drug abuse in psychiatric patients and motor vehicle accidents (MVA) cases, among others. A medical record review summary only highlights the positive substances, although the screen can cover various substances and drugs, including amphetamines, opiates, benzodiazepines, barbiturates, etc.

The collected date (date of blood draw, submission of urine sample) plays a significant role here and becomes crucial in the chronology of the report.

Medical Record Reviews

Attorneys need a medical record review summary to solve disputes with patient care.

Medical record reviews involve going through the patient’s entire medical history right from birth and need to be simplified to help the attorneys to present the medico-legal case.

The patient’s medical charts include various laboratory studies performed at different times of the patient’s life. An attorney reading these enormous records might not understand the relevance of the numbers involved in lab studies. Imagine an English teacher evaluating a complex math paper and trying to make sense of all the numbers and alphanumerical values. For this reason, a medical record reviewer prepares a summary that involves only the abnormal values from these laboratory tests. A reference range is also provided for the attorneys, along with these abnormal values, to help them consolidate their arguments.

Denial of Insurance

There are circumstances where a test such as atherosclerotic cardiovascular disease (ASCVD) risk score results in denial of coverage for certain drugs from insurance, severely impacting patient care.

In some cases, lab records (such as clinical, molecular, hospital or pathology) become the backbone of the legal proceedings involving insurance claims. As discussed earlier, coverage is sometimes denied based on the lab records of the patients over the years. The reasons could range from lab tests performed without prior authorization and being medically unnecessary to not being covered by an insurance plan.

Substance abuse, being seen as a social or a criminal problem, needs additional responsibility from the healthcare systems, and these patients have only limited options in terms of insurance coverage.

When the presence of human immunodeficiency virus (HIV) is spotted in any laboratory tests while reviewing the patient’s medical records, the medical record review is stopped immediately as HIV/AIDS as a pre-existing condition is not covered by insurance even after enduring the waiting period in the United States.

A seasoned medical records reviewer can quickly identify such disease conditions in the patient’s medical records and will be able to stop the reviewing process at the appropriate time and inform the team about the same. However, it requires skill and a clear understanding of each component in the laboratory report.

PreludeSys Advantage

A medical records reviewer in PreludeSys goes all-in to provide a concise, well-constructed summary that helps attorneys relax with all the numbers, urine toxicologies, and pathologies that are part of the laboratory reports.

PreludeSys understands the significance of lab records in the patients’ medical records and has a high degree of expertise in delivering case-specific review summaries.

PreludeSys is an ISO 27001:2013 certified medical record review service provider. Our comprehensive medical record review solutions include obtaining relevant records from the medical repository, medical record indexing, and a no-holes-barred summary process. In addition, we provide end-to-end data protection with HIPAA compliance as the benchmark at competitive rates. Contact our team now.

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