Medical Case Review

Medical record review or case review is a cornerstone of HSAG services and a core competency of the company. HSAG conducts individual case review to address quality concerns and assist managed care organizations in addressing and preventing client concerns. During the course of the review, any potential quality-of-care concerns are referred to an HSAG physician reviewer for determination.

HSAG also performs retrospective individual case reviews to address inefficiencies and delays in care, testing, scheduling, opportunities for enhanced care, inappropriate admissions and/or levels of care, length of stay appropriateness, readiness for discharge, and quality-of-care issues.

HSAG provides medical case reviews for public and private customers throughout the United States. Since 1979, one of HSAG's core competencies has been data retrieval and medical record audits. HSAG conducts medical reviews for Medicaid programs, the Department of Defense; private, self-funded plans; the Arizona Department of Insurance; and managed care plans, in addition to the Medicare program. HSAG staff members have conducted more than 1 million medical record reviews since the company began this activity.

To facilitate the medical record review process, HSAG has developed an extremely successful Medical Record Retrieval System (MRRS). A major component of the MRRS is a computer application that was developed by HSAG in MS Access. This program greatly assists the staff in tracking medical record requests and monitoring medical record compliance rates.

HSAG performs (or has performed) medical record reviews for the following:

• Care provided to Medicaid beneficiaries
• TRICARE, the military health system for beneficiaries such as dependents and retirees
• The CMS Payment Error Rate Measurement (PERM) program
• Self-funded employer groups