External Peer Review Mechanics

• Determine Preferred EPR Provider:
  • Routine & Expedited Completion Time
  • Capability to serve as a Hearing Officer
  • Physician Specialty Availability
    
  • Ability to Perform Peer Review Effectiveness Assessment
  • On & Off-Site Capability & Rates
    
  • Clinical Department, Group Practice, Medical Staff-wide
  • Evaluation methods;                                                 
  • Stand Behind Review Findings: Calls, Visit Organization/Court
• Confirm that the EPR Criteria meets your EPR policy
• Contact the EPR provider to confirm:
  
  • Reason for the Review & Case Selection 
    
  • Confidentiality & Indemnification Agreements             
    
  • Efficient Sample Size & Effective Review Method
    
  • On/Off-site Determination;
    
  • Medical Records Format (Electronic/Paper/CD)
    
  • Due Dates of the Final Report & Report Format
    
  • Reviewer Credentials, Privileges, Location & Facility 
    
  • Not-to-Exceed Total Cost
    
  • Need for Conference Call(s), On-Site meeting, hearing, court appearance  
• Review with the Clinician Being Evaluated: The Reason for the Review;  The Case Selection, Sample Size, Methodology; The Clinical Reviewer Background; & Their Portion of the Review Cost (if appropriate).
• Approve & Return EPR Vendor Agreement with Confidentiality, Indemnification & Medical Records. Specify if Records are Destroyed After the Review or Returned to the Hospital/Group Practice. (Agreement Updated every Two Years)
• Records Sent Electronically Encrypted or Compact Disk Sent via Overnight Courier with Security Code Sent via email with Confirmation Upon Receipt,
• EPR Vendor to Manage the Process with the CEO, CMO, MSP, Risk or Quality Management per Agreement.
• Receive Written Report (consider who receives it: MEC, Admin, Legal, with advance verbal preview).
• Determine if the Report will be Reviewed at the MEC, or in Advance by the Peer Review Committee/Chair or CMO and then Discussed at the MEC.
• Determine if Follow-up Call or Visit from the Clinical Reviewer is Necessary.
• Conduct Final Call EPR Vendor to Review Satisfaction with the Process. ​