File review involves reading medical records, searching the medical literature, reviewing medical insurance contracts, then answering questions, and writing reports.
The work is paid for by insurance companies and independent review organizations, the third party middlemen who review proposed treatment for medical necessity.
If you think you might like to do expert witness work, file review can be a good place to start. You gain experience reviewing records on some nights and weekends while getting paid and keeping your full time job.
Within the health care industry, an independent review organization (IRO) acts as a third-party medical review resource which provides objective, unbiased medical determinations that support effective decision making, based only on medical evidence. IROs deliver conflict-free decisions that help clinical and claims management professionals better allocate healthcare resources.
By applying independent medical peer review, patients and insurance companies can often avoid repetitive, unnecessary or invasive procedures that ultimately do not benefit the patient. As the complexity of medical treatment increases, medical peer review and IROs are becoming a valuable resource for insurance companies and their patients. The independent medical peer review process provides peer reviewed, evidence-based clinical determinations for all parties involved with the case under review.
At first this seemed OK - some intellectual stimulation and some sense of doing something useful.
But after a while, I grew to dislike it for several reasons
1) I rarely seemed to get all of the records I needed
2) The ground rules are stacked against the the patient, so I would often wind up having to agree with the denial when I really thought the patient should get the treatment. To the insurance company, Medicare, and the middlemen, it doesn’t really matter if the the treatment “makes sense” or if the patient does not have any other options or if new data, albeit weakly, suggests that the patient might benefit. What matters is the wording of the contract.
3) I always felt my arm was being twisted to side with the denial
4) I had to say things a certain way.
5) Pay is low - $130 per hour for a medical specialist when I quit doing it 3 years ago.
The only company that I enjoyed working for was Provider Resources. This company reviews health care decisions and outcomes for veterans treated at VA hospitals. Here I was doing something to improve the health care for those who protected us. Usually a VA attorney was involved because there was concern about inadequate care or because a Veteran or his/her family had filed a law suit. This was not expert witness work, but rather internal work for the VA, so it paid the same as the file reviews, not the same as expert witness work. My favorite part was when the attorney, towards the end of a series of questions would ask: 7) assume you are testifying for the VA; please give the strongest arguments in favor of the actions of the VA medical staff; and then: 8) assume you are testifying for the plaintiff; please give your strongest arguments in favor of the plaintiff’s case.
Because this is internal work for the VA, you never have to testify or give a deposition. So if you are looking to cut back some and supplement your income, but you don’t want to have to testify in court or give a deposition, try Provider Resources. It is easy to back out and change your mind if you want to do something else or go back to full-time practice.
If you think you might like to do expert witness work, file review is a good start and you can do some of it even with a full time job.
File review