chart review is a board term. in addition to the description noted in previous blogs, this could also include chart review to validate reimbursement and coding issues looking for appropriateness of bills or claims filed with medicare/medicaid, workmens comp, or private/commercial insurance plans. there are many factors that trigger chart review.. under and over charges, suspected fraud and abuse, determining prospective payment schemes for the government, looking for patterns of coding groupings for drg or opps, and other settings such as physician practice, dme, home health etc.
to learn more about medical audit, visit aamas -
american association of medical audit specialists
for quality issues --- these could be preparing for accreditation such as jcaho, ncqa, urac or hedis review. this is how nursing can be exciting as it leads to tons of opportunities in addition to the typical bedside clinical nursing.
chart review is also involved with research or determining patient safety concerns with clinical trials, emerging technology or new products involved in clinical care.