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:
“The ability to secure an independent livelihood and honorable employ suited to her education and capacities is the only true foundation of the social elevation of woman, even in the very highest classes of society. While she continues to be educated only to be somebody’s wife, and is left without any aim in life till that somebody either in love, or in pity, or in selfish regard at last grants her the opportunity, she can never be truly independent.”
—Catherine E. Beecher (1800–1878)
“Unusual precocity in children, is usually the result of an unhealthy state of the brain; and, in such cases, medical men would now direct, that the wonderful child should be deprived of all books and study, and turned to play or work in the fresh air.”
—Catherine E. Beecher (1800–1878)
“Generally there is no consistent evidence of significant differences in school achievement between children of working and nonworking mothers, but differences that do appear are often related to maternal satisfaction with her chosen role, and the quality of substitute care.”
—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)