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Physician Consultants <LOG
IN>
Physician Consultants
are a vital component of NHCQF’s efforts to improve the quality of care and promote
appropriate utilization of services for Medicare beneficiaries. More than 220 Physician Consultants,
representing all major medical/surgical specialties and a variety of practice
settings, share their expertise in the review process by evaluating individual
medical records. Cases for review
come from a number of sources such as complaints from beneficiaries about the
quality of care they have received, hospital issued notices of non-coverage,
hospital-requested higher weighted diagnosis related groups (DRG)
determinations, random sample reviews for the Hospital Payment Monitoring
Program and violations involving the Emergency Medical Treatment and Active
Labor Act (EMTALA).
When you become a
Physician Consultant at NHCQF you will
make a difference. Your medical
knowledge, clinical experience and skills are essential to NHCQF to impact
patterns of care that will lead to measurable improvements in quality of care
and appropriate payments for Medicare services. You should also regard this opportunity as an excellent way to
serve your peers.
Requirements:
To become a NHCQF Physician Consultant you must:
• Be
licensed in the state where the care being reviewed was rendered (i.e. Maine,
New Hampshire and/or Vermont).
• Have
active hospital staff privileges at a hospital in Maine,
New Hampshire and/or Vermont.
o Active
staff privileges mean that a physician is authorized on a regular, rather
than infrequent or courtesy basis, to order an admission to a facility;
perform diagnostic services in a facility; or care for and treat patients in
a facility. Emergency room physicians who do not have admitting privileges in
an acute care hospital can meet the requirement of active staff privileges.
• Be
engaged in a clinical practice of medicine for at least twenty hours a week,
and routinely treat Medicare patients.
As a
Physician Consultant:
• You
will be trained and compensated for your role in the review process.
• You
will not review cases where the care rendered was provided in your own hospital
or cases where there might be a conflict of interest.
• You
will decide how many cases you want to review and how often. (On average, a
physician consultant may be asked to review approximately one to three cases
each month, but that depends on the volume of work received and the
specialties required.)
• You
will spend an average of about twenty minutes on each case, but some cases
could take more or less time.
• You
will decide where you would like the cases sent for your review.
Frequently Asked Questions:
If I am retired, do I still qualify to be an
NHCQF physician consultant?
No. Physician
Consultants must be in active practice to perform reviews for NHCQF.
How quickly do I have to turn around a review?
Review timeframes vary greatly.
NHCQF needs physicians to complete most reviews within 7-10 business days.
However, occasionally there are reviews that must be turned around in less
than 24 hours. When we send you a case for review, we will check to make sure
you are able to comply with the timeframe assigned to the case.
How do I get cases to review - do I have to come
to the NHCQF office?
No. NHCQF will mail the
cases to you, enclosing a postage paid envelope so that you can mail the
cases back without incurring any mailing costs.
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