Independent medical review is the process where physicians review medical cases in order to provide claims determinations for health insurance payers, workers compensation insurance payers or disability insurance payers. Peer review also is used in order to define the review of sentinel events in a hospital environment for quality management purposes such as to look at bad outcomes and determine whether or not there was any mis-diagnosis, mistreatment or any systemic problems involved which lead to the sentinel event.
Physicians who perform independent medical reviews must be board certified and in active practice in that same area of treatment. These physicians are contracted by an independent review organization, medical management companies, third party administrators (TPAs) or utilization review companies to provide objective, unbiased determinations on what the root cause of the treatment was, whether or not there is medical necessity, if there was a sentinel event, what was the reason for it, etc.
Famous quotes containing the words independent, medical and/or review:
“It is so rare to meet with a man outdoors who cherishes a worthy thought in his mind, which is independent of the labor of his hands. Behind every man’s busy-ness there should be a level of undisturbed serenity and industry, as within the reef encircling a coral isle there is always an expanse of still water, where the depositions are going on which will finally raise it above the surface.”
—Henry David Thoreau (1817–1862)
“The greatest analgesic, soporific, stimulant, tranquilizer, narcotic, and to some extent even antibiotic—in short, the closest thing to a genuine panacea—known to medical science is work.”
—Thomas Szasz (b. 1920)
“The thanksgiving of the old Jew, “Lord, I thank Thee that Thou didst not make me a woman,” doubtless came from a careful review of the situation. Like all of us, he had fortitude enough to bear his neighbors’ afflictions.”
—Frances A. Griffin, U.S. suffragist. As quoted in History of Woman Suffrage, vol. 4, ch. 19, by Susan B. Anthony and Ida Husted Harper (1902)