Ophthalmology File Review Consultant

An ophthalmology file review consultant may analyze medical information for a wide variety of important reasons.  Medical reviews are utilized by independent review organizations, disability analysts, insurers, attorneys, and third party administrators.

Disability Reviews
Claims filed by individuals who report impaired or loss of vision may be analyzed by a board-certified ophthalmologist.  Past and current medical records are carefully reviewed.  Depending on the assignment, a review may address an alleged date of onset of physical impairment, degree of impairment, treatment options, and prognosis.  On occasion, a third party may request an independent medical examination as a means of obtaining a second opinion.

Authorizations
An ophthalmology file review consultant may be utilized when questions arise regarding authorizations for a plan for treatment.  Surgical intervention or unconventional treatment methods may be analyzed to determine their validity and whether they conform to the standard of care.

Legal Analysis
Standard of care issues are among the key concerns when evaluating proper care.  The general definition of standard of care pertains to whether or not an action was within the scope of what a reasonable and prudent practitioner would do under similar or identical circumstances.  Appropriate diagnosis that is consistent with history and physical findings are important.  Findings and measurements from diagnostic equipment are interpreted and compared with information obtained from physical findings.

Terminology for Ophthalmology
Every medical specialty has unique terminology.  Ophthalmology has a broad vocabulary and a specialized set of abbreviations.  An ophthalmology file review consultant may be consultant to interpret a medical chart so that an administrative part may be able to understand the information contained with the record.  A complete understanding is often needed to make appropriate decisions that are supported by accurate information.

Reports
A report is often needed as documentation used in the administrative process.  It is important that the report be objective and contain opinions that are supported by reliable facts.  A report is particularly valuable when it is easy understandable.  Reports that are replete with unexplained abbreviations may be confusing.  Similarly, reports need to be readily understood by lay persons such as jurors.  The questions addressed in a report are determined by the assignment given to an ophthalmology expert.

An ophthalmology file review consultant is a valuable resource for a variety of purposes.  Appropriate analysis of claims for disability and medical benefits are some of the many tasks that may be fulfilled in a file review.  Reports from a file review are a cornerstone for decisions by third party administrators.

Michael Reynard, M.D. has served as a registered file review consultant for Social Security Administration.  He also provides file reviews for a number of companies and third-party administrators.  Contact information: reynard@ucla.edu

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