Physician review for the Medicare Beneficiary Protection Program
What is Medicare physician review?
Physician reviewers conduct medical record review to determine whether the care received by Medicare beneficiaries was medically necessary and appropriate. Review situations include quality of care complaints and appeals of discharge and Medicare noncoverage notices issued by providers and health plans. Issues may include utilization, coding, or quality of care.
How to become a physician reviewer
Acumentra Health is seeking physician reviewers in primary care and speciality areas. If you are interested in becoming a physician reviewer and meet the qualifications listed below, submit an application packet to Acumentra Health and we will contact you with more information.
Reviewer qualifications
A physician reviewer must
- be a licensed doctor of medicine, osteopathy, dentistry, podiatry, or optometry
- be engaged in active practice in Oregon or be a military physician in active practice in a military or Department of Veterans Affairs facility in Oregon
- practice on a routine basis at least an average of 20 hours per week
- see Medicare beneficiaries on an ongoing basis throughout the year
- have staff privileges in an Oregon hospital, except emergency room physicians, doctors of optometry, and dentists
- enroll as an Acumentra Health physician member (may apply simultaneously with reviewer application)
Resources for physician reviewers
Administrative tools
- Quality Review Categories & Actions Checklist
- Criteria for discharge reviews in SNF, home health, and hospice settings
Timesheets
Contact Acumentra Health for the appropriate timesheet:
- BIPA, Grijalva, and other discharge reviews
- Other Medicare reviews
Information
Confidentiality documents
Contact us for the most recent Acumentra Health policy documents.
Contact
For more information use our contact form.