There are two primary types of peer review. One is used to manage physician performance and ensure providers’ skills are held to the highest standards. The other is a physician-level review of medical records utilized by health plan professionals to determine whether or not to uphold a denial of coverage for a specific claim. 

The main goals of peer review are to improve the quality and safety of patient care, reduce an organization’s malpractice liability and meet regulatory requirements. These include accreditation, licensure, and insurance participation. Physicians consult the most up-to-date and industry accepted clinical guidelines, backed by evidence-based medicine, to ensure their reviews are accurate.  

IMR: Benefits of an experienced resource 

For independent medical review (IMR) or medical case review, healthcare providers may opt for an external peer review company when they lack the appropriate internal resources, such as employees, time, […]