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Retrospective review is the type of UM that occurs after the care was delivered and after the bill for that care was submitted. The retrospective review seeks to confirm that the care was appropriate and was provided at the most efficient and effective level.
Retrospective audits involve reviewing claims that have already been submitted and preferably adjudicated as either paid, denied, or pending.
All research, retrospective or otherwise, that will contribute to professional knowledge must have IRB oversight. There are exemptions to the regulations, and ophthalmologists are advised to review the OHRPs website at .hhs.gov/ohrp to familiarize themselves with these regulations.
Post-Service Review (Retrospective Review): The review of a request for a service/care that has already been rendered by the provider.
Prospective studies usually have fewer potential sources of bias and confounding than retrospective studies. A retrospective study looks backwards and examines exposures to suspected risk or protection factors in relation to an outcome that is established at the start of the study.
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