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, appeals of hospital issued notices of non-coverage, hospital-requested higher weighted diagnosis related groups (DRG) determinations, violations involving the Emergency Medical Treatment and Active Labor Act (EMTALA) and miscellaneous reviews.
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.
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.
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.
For more information about Review Services please contact the
NHCQF Beneficiary Programs:
Phone: 1-800-772-0151, Ext. 165
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