Consulting
When you become a physician reviewer at Health Care
Excel you will make a difference. Your medical
knowledge, expertise, and skills are just what Health
Care Excel needs to impact patterns of care that will
lead to measurable improvements in quality of care and
outcomes for thousands of Medicare and Medicaid
beneficiaries. In addition to improving patient care,
you should regard this opportunity as an excellent way
to serve your peers. Health Care Excel's work has
evolved as the needs of health care have changed.Requirements
- Physician reviewers must be licensed in the state where the review is occurring.
- They must have active hospital staff privileges at a hospital within the state of the case under review.
- Physician reviewers must be engaged in a clinical practice of medicine for at least twenty hours per week, and see Medicare patients in the course of the reviewer's clinical practice of medicine.
Cases for review come from a number of sources such as beneficiary complaints, hospital issuance of notices of non-coverage, hospital-requested higher weighted diagnosis related groups (DRG) determinations, and violations involving the Emergency Medical Treatment and Active Labor Act (EMTALA).
As a physician reviewer
- You will be thoroughly oriented, trained, and compensated for your role in the review process.
- Physicians will not review cases in their own service areas or cases where there might be a conflict of interest.
- Typically, a physician reviewer may be asked to review approximately five to ten cases each month, but that depends on the volume of work received and specialty required.
- Physician reviewers may decline or accept review on a case by case basis. Most cases average about twenty minutes each, but some could take longer or shorter. You decide where you would like the cases sent for your review.
Should you decide to become a physician reviewer for Health Care Excel, you would be joining our team of epidemiologists, clinicians, nurses, statisticians, and researchers. At Health Care Excel, it is believed that by working together we will make a difference in the quality of life for Medicare and Medicaid beneficiaries.
