What is the main focus of a retrospective review?

A retrospective review primarily focuses on examining claims for services that have already been received. This means that it looks back at the medical services provided to patients and evaluates whether these services met the criteria for medical necessity, appropriateness, and compliance with payer policies. This process is important for ensuring that the claims submitted by healthcare providers were justified and that the billing practices are accurate.

The review typically assesses the patient's medical records, the treatments provided, and the outcomes to determine if the care aligned with established standards and guidelines. Such evaluations can help identify potential issues with claims submissions, including discrepancies that might need to be addressed for reimbursement purposes. This is crucial for both insurers and healthcare providers in managing costs and ensuring quality care.

Looking at the other options, they focus on forward-looking elements or aspects of healthcare that do not pertain directly to evaluating past services provided. For instance, assessing future medical necessity involves predictions about what will be needed going forward rather than analyzing what has already occurred. Evaluation of new insurance policies pertains to the determination of coverage for future services rather than reviewing past claims. Lastly, preventative care measures focus on actions taken to avoid health issues rather than reviewing what has already been done. Thus, the central role of retrospective review is its concentration on previously provided services