Our Physician File Review takes a retrospective look at the necessity and appropriateness of medical treatment.
Comprehensive Analysis From Physician Experts
For post-treatment evaluations, our Physician File Reviews deliver a complete assessment of whether the:
- Provider charges correspond to the medical records submitted
- Treatment rendered was appropriate
- Current condition is causally-related
- Patient can return to work and in what capacity, for workers’ compensation cases
- Patient has reached maximum medical improvement (MMI)
Rising enlists experienced, objective medical professionals and peer reviewers to carefully analyze medical records and evaluate the care provided. The resulting assessments supply payers with the tools needed to facilitate fair and equitable case resolutions.
Our Physician File Reviews are beneficial when one or more of the following exists:
- Claim charges exceed $2500
- More than 15 visits to the same provider
- Questionable relatedness or reasonableness of treatment
- Potential pharmacy overutilization
- Aggravated or exacerbated pre-existing condition
- Catastrophic or permanent injuries
- Frequent specialty consultations / diagnostic testing
- Delay in reporting the injury or seeking treatment
- Lack of documentation or detailed treatment plan
