- An overview of common types of chart review jobs for physicians
- Things that chart review jobs for physicians have in common
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Many physicians seeking a source of side income or who are transitioning to nonclinical work look into chart review as a possibility. Chart review jobs for physicians are appealing for several reasons – they can often be done from home on a flexible schedule and tend to pay quite well.
There is a common misconception, though, that chart review is a single type of work. The term “chart review” is colloquially used to refer to any activity in which a person of authority formally examines medical documentation with the intention of using the findings to make a decision about a predetermined question, or to identify information that will assist in answering that question.
The differences between various types of chart review jobs for physicians can impact:
- Whether you’re qualified to do the work
- The amount of work that is likely to be available
- How interesting and enjoyable the review will be for you
- The expected compensation
It’s helpful to be familiar with the various types of physician chart review both to assist in finding work and to help you make a wise decision when accepting job opportunities.
An overview of common types of chart review jobs for physicians
The sections below describe the main types of chart review jobs for physicians to provide you a place to start in your search.
Chart review for medical necessity determinations
Medical necessity chart review is performed by both health insurance companies and health delivery organizations to keep costs down and ensure the appropriateness of care. It’s often done as a part of a utilization management program.
The most common types of review for this purpose are pre-authorizations and concurrent hospitalization review. For non-urgent medical services, healthcare payors require that requests for services be submitted for authorization before they actually take place. Requests that are not straightforward or not always covered under the member’s plan are reviewed by a physician.
Reviews taking place during hospitalization – which are known as concurrent reviews – are performed to determine expected length of stay, to decide whether ongoing hospitalization is medically necessary, and to verify that the appropriate level of care is being used.
This type of review is your best bet if you’re looking for a full-time job in which you primarily perform chart reviews. Many medical director positions with health insurance companies include a component of chart review. Some payors use a third-party company to do the bulk of their medical necessary reviews. These are known as independent review organizations and are another employment option for physicians wanting to do chart review work.
Hospitals often hire one or more physicians to assist with utilization management. The chart reviews themselves are similar to concurrent reviews done by insurance companies. The main difference is that reviews performed by the hospital don’t directly affect payment for services; rather, they are used to prevent denials of payment by preempting payor determinations.
Chart review for disability and workers’ compensation claims
The purpose of physician involvement in workers’ compensation and private disability claims is to form a medical opinion as to what extent a worker’s injury restricts him from performing the usual and customary duties of work. Injured workers pursuing disability benefits need to be evaluated and approved by the insurance company.
Employees with work-related injuries are treated by their own doctors, but the result of their disability insurance claim depends on the determination made by the insurance provider. In straightforward claims, this may not involve a physician at all. In other claims – such as those that are expensive or involve disputes or disagreements – a physician who is otherwise uninvolved in the worker’s care becomes involved.
Physicians are asked to provide an opinion about various aspects of the injury and its impact on worker statuses such as the expected disability duration, ability to return to work, and causality of the claimant’s injury. This always involves a chart review and sometimes includes an in-person exam, known as an independent medical exam, or IME.
The term “file review” is typically used in disability review cases rather than “chart review” because it’s a broader term that encompasses a review of both medical documentation and information about the injury and work performed by the claimant.
Physicians performing this type of review are most often hired by the insurance company or a third-party administrator, though may also be hired by a self-insured company, state agency, union, or legal firm working on behalf of the employee.
Similar reviews are sometimes required as part of auto insurance claims.
Chart review for insurance underwriting
Physician chart review for insurance underwriting is most commonly used in the life insurance industry. Before selling someone an insurance product, a life insurance company needs to make a prediction about how long that individual is expected to live and what medical problems put him at risk of death.
Physicians employed by life insurance companies may also be involved in chart reviews after a claim is made. In this situation, they opine on the cause of death based on medical record review.
There are opportunities for full-time work with life insurance companies, though these are quite limited compared to the number of positions in medical necessity review work.
Chart review for legal cases
Physician chart review for legal cases is frequently referred to as expert witness work. In legal matters involving medical diagnoses and treatment, judges and juries need information from a member of the medical profession such as whether the medical care provided was appropriate or whether there was medical negligence or a violation of medical standards.
This type of chart review is carried out by physicians who are retained by the lawyer representing either the plaintiff or defendant. The expert is provided with medical records and other documentation in order to form a statement about the medical care that was provided.
As with disability review work, more than just a file review is needed in some situations. Experts are often required to provide depositions or testimony in court.
Chart review for clinical documentation and coding
Physicians working in clinical documentation improvement (CDI) perform chart reviews from a medical coding perspective. These reviews are typically done concurrently with a hospitalization so that documentation can be corrected before a claim is filed with the payor.
Most CDI tasks are done by staff with a nursing background, working closely with a team of coders. However, many hospitals involve a physician in order to review complex cases and to assist in communication with treating providers. Physicians are often employed by the hospital in a physician advisor or similar role. Some hospitals partner with vendors who offer CDI or physician advising services.
Chart review for quality management and oversight
Chart review is often a component of healthcare system administrative positions held by physicians.
Medical directors of many types are responsible for peer reviews to ensure that care being provided is appropriate, that documentation is complete, and to meet company policy requirements. Certain types of settings, such as laboratories, are required to have chart reviews performed by the medical director for ongoing certification.
Quality improvement projects in hospitals and healthcare systems regularly have a component of chart review to gather data prior to making changes to processes or policies. Physicians may assist with the reviews, depending on the project and data needs. This is most likely to be done by a clinical physician as part of a one-off project or quality committee initiative.
Chart review for collaborating agreements
Physicians collaborating with nurse practitioners are generally required to perform chart reviews as a component of the collaborating agreement. The specific requirements vary by state, though a typical agreement would be that the physician reviews 10 charts or 10% of the NP’s encounters each month.
Many collaborative agreements are set up exclusively between the physician and the NP. However, there are some consulting positions available in which a third-party hires a physician and assists with the logistical aspects.
Chart review for medical research
Similar to quality improvement projects, chart review can be used to gather data for research projects. Physicians working for an academic medical institution may have the opportunity to take part in this type of study as an element of a broader role.
In most cases, physicians are unlikely to be the ones actually reviewing charts and abstracting data. It is more common that they’re involved in study design and other high-level aspects of the research. Nonetheless, this can be a great way for students and residents to begin doing chart review and potentially get published at the same time.
Things that chart review jobs for physicians have in common
Most chart review jobs for physicians have several things in common:
- They are intended to be an objective and impartial review of a medical case.
- They require or benefit from the experience and knowledge of a trained medical professional.
- The reviewing physician does not make treatment decisions or direct the patient’s care.
Physician chart reviews of many types are commonly referred to as peer review processes. This is a broad term meaning that the physician reviewer is a “peer” of the clinician who is diagnosing and treating the patient whose records are being reviewed.
For readers interested in doing chart review work, hopefully this sheds some light on the various types available and helps to guide your efforts in finding work!