Choosing a Different Peer Review Vendor

Not all Peer Review Programs are equal. Therefore, it’s important you understand the differences from one program to another, as these differences can determine the efficiency and effectiveness in how your claims process operates.

Your Peer Review vendor should be a perfect fit for your organization and if you have any reservations about the progress and efficiently of your peer review program, it may be time for a different vendor. By arming yourself with the correct knowledge to make educated decisions, you will be able to forge a successful partnership.

From the level of accreditation to the timeliness and accessibility of information, there are many boxes your peer review vendor should fill. The following checklist will help you understand what to look for in a peer review program. Asking these questions about your current peer review vendor will help you gain insight and knowledge, preparing you and your peer review program for success.

Choosing your Peer Review Program doesn’t need to be a chore.  It doesn’t need to be filled with confusion or anxiety.  The key lies in asking the right questions.

Checklist:

1. Is your Peer Review Program accredited?
   • Accreditation status can be the difference between the highest quality service/support and bad services/issues.  Accredited IROs must comply with important federal and state standards and timelines, ensuring you receive quality support that will help you create efficiencies for your peer review program.

2. How easy it for you to submit your reviews, have them reviewed, and receive the results?

• Ensure review interfaces are user friendly and open to multiple users.  While some vendors may be innovative, their technology might not be efficient and accurate.

3. Do you have a dashboard that tells you the status of each review?
   • Innovative and cutting edge technology can save you time and money when it comes to your peer review program.

4. Do you have access to reviewers licensed in every state?
   • If not, looking for an organization with reviewers licensed in every state will be critical to the success of your peer review program.

5. Is your Peer Review Program compliant with the ACA?
   • Following federal guidelines is must, peer review programs out-of-date on regulations and standards can be a great liability to your organization.

6. Do you have a dedicated Peer Review Coordinator?
   • Appoint a point person to be responsible for gathering and analyzing regulatory updates and changes, and communicating these changes to your internal team on a regularly scheduled basis.

7. Can your Peer Review Program accommodate both medical and behavioral health reviews?
   • Don’t be left behind as the healthcare industry shifts. Behavioral Health is major trend in healthcare and having a peer review program that can accommodate both medical and behavioral health reviews will keep you innovative and current.

If you answered no to any of these questions, you may need a new Peer Review Program.

BHM offers URAC accredited Peer Review Programs with a state of the art peer review portal system, physicians licensed in every state and in almost every discipline, an option for both medical and behavioral health reviews, a dedicated peer review coordinator, and the desire to customize any of our processes to meet your specific needs. Click here to find out more about how we can help you change peer review vendors.