OFMQ conducts medical reviews as part of its contract with the Centers for Medicare & Medicaid Services (CMS) and as a certified Independent Review Organization (IRO) and External Quality Review Organization (EQRO).
Physician reviewers conduct medical record review to determine whether care provided was medically necessary and appropriate. Reviews may include utilization, coding or quality of care issues. The reviewer is generally from the same specialty as the physician that provided the care in question. This peer review is important to maintaining high standards of practice within the medical profession as well as a key component to the Medicare Quality Improvement program.
Reviewing physicians are compensated for review time. A physician reviewer must meet the following eligibility requirements:
- Have active admitting privileges at a provider facility
- Have a practice that includes inpatient admission and treatment of Medicare patients
- Be actively engaged in patient care a minimum of 20 hours per week
- Have a current license to practice Medicine within the state of Oklahoma
- Submit curriculum vitae
- Be board certified
If you are interested in becoming a physician reviewer, complete the Physician Reviewer Registration Form and fax to OFMQ, Attn: Kathi Bailey at 405.840.1343.