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:
“A wise parent humours the desire for independent action, so as to become the friend and advisor when his absolute rule shall cease.”
—Elizabeth Gaskell (1810–1865)
“Every day our garments become more assimilated to ourselves, receiving the impress of the wearer’s character, until we hesitate to lay them aside without such delay and medical appliances and some such solemnity even as our bodies.”
—Henry David Thoreau (1817–1862)
“Americans have internalized the value that mothers of young children should be mothers first and foremost, and not paid workers. The result is that a substantial amount of confusion, ambivalence, guilt, and anxiety is experienced by working mothers. Our cultural expectations of mother and realities of female participation in the labor force are directly contradictory.”
—Ruth E. Zambrana, U.S. researcher, M. Hurst, and R.L. Hite. “The Working Mother in Contemporary Perspectives: A Review of Literature,” Pediatrics (December 1979)