faq-reviewer

We choose a review consultant in the appropriate specialty from our panel and mail the with a cover letter identifying the question(s) to be answered and return postage for the consultant’s report. The consultant reviews the case and returns the report to us by the due date, usually 7–10 days. We standardize the report and forward it to the client.

We have a panel of over 250 reviewers. A registered nurse on our staff reviews the medical record to determine the most appropriate specialty. The review consultant selected must be board certified in their area of practice, have experience within the previous year in the area of review, and have no conflicts with the parties involved in the case.

Not usually. Additional areas of discussion or concern must be addressed directly with us, and we will communicate those concerns to the client.

The identities of our reviewers are kept confidential. We identify them to clients by number only. We believe this contributes to the objectivity of the review.

The reviews tend to be primarily of two types: utilization and quality.

Insurance companies usually ask utilization questions. For example, was the surgery medically necessary? Could the patient have been discharged a certain number of days earlier? Could this service have been provided on an outpatient basis?

Hospitals generally ask quality questions. For example, was this case managed appropriately?

Each chart we send you will generally take an hour or less for the utilization issues and up to three hours for quality issues. You may specify how frequently we may send you charts or, if you are too busy to review a particular chart, you can send it back within 48 hours.

We require all of our reviewers to be board certified, involved in at least 20 hours/week of clinical practice during the previous year, have a minimum of 5 years clinical experience, and have passed our credentialing process.

We ask that you give each review your thoughtful evaluation, write a concise summary of your findings, include specific rationale for your decision, and cite references when able. We also ask you return the reviews by the due date requested, generally 7–10 days.

Yes, we reimburse the reviewer within 30 days of completion. Please contact Physician Review Organization for a fee schedule.