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Peer Reviews

Peer Reviews Peer Reviews

An OHS physician examines all medical records, including films and diagnostics and documents a report based upon the findings. Reviews address all requested issues to include diagnosis, causality, appropriateness of treatment, as well as any pre-existing conditions.

Specific Reviews are as follows:

Medical Records Analysis/Synopsis (available with each of the services listed below)

Medical records are sorted chronologically and a comprehensive summary is prepared of all records in an outlined form, documenting all treatment, medical records and testing.

Prescription Reviews

A physician evaluates how prescribed medications correlate with the illness/injury, appropriateness of their usage, contradictions, over-utilization and side effects. If applicable, a weaning program will be addressed. The physician may also recommend over-the-counter medications to substitute for prescription drugs.

MRI Rereads

The physician will evaluate all available MRI films and reports. The physician's report documents his opinions as to the accuracy of the diagnosis and previous impressions.

EMG/NCV Rereads

An OHS physician, who is board-certified in physical medicine and rehabilitation as well as electro-diagnostic medicine, reviews EMG/nerve conduction studies to provide a detailed critique on the credentials of the practitioner who performed the study, the study's technical quality and the validity of the diagnosis. The physician's opinions are based upon well-established electro diagnostic and medical criteria and protocols

Compensability Reviews

A compensability review examines the cause and nature of an injury during the initial phase of the claim to determine the future process management of the claim. An OHS report discusses the symptoms, diagnosis and cause as well as any unrelated diagnoses and/or pre-existing conditions.

Prospective Reviews / Pre Authorization

A prospective review assesses and authorizes the medical necessity of a prescribed course of action before the care is provided.

Concurrent Reviews

This peer review helps determine the medical necessity of ongoing treatment and the treatment protocol's connection to the cause of injury. Communication with the treating physician is attempted for the purpose of an agreed upon treatment plan.

Retrospective Reviews

A retrospective peer review is an assessment of medical necessity of treatment, cause and extent of injury, and ability to return to work.

Third-Party Liability Review Service

A physician peer review will address the accuracy of the diagnosis and causal relationship to the incident, as well as identify any unrelated diagnoses and/or pre-existing conditions.

Demand Package Review

This service combines a medical review and bill audit to assist the adjuster in determining the value of the case settlement/demand. A medical peer review addresses the accuracy of the diagnosis and causal relationship to the incident, and identifies any unrelated diagnoses and/or pre-existing conditions. A medical bill review determines the accuracy of all provider and hospital charges. OHS also provides a summary of bill reductions based upon state reimbursements and other factors.