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We are looking for information on appropriate review numbers. Is there a standard for the number of reviews an overseeing Physician should perform on a mid-level provider?
Although the standards for peer review are outlined in Chapter Five, Clinical Staffing (Chapter 5: Clinical Staffing) and Chapter Ten, Quality Improvement/Assurance (Chapter 10: Quality Improvement/Assurance) of the Health Resources and Services Administration (HRSA) Health Center Program Compliance Manual, the number of reviews required by the health center are not specified. Chapter Five discusses the need to factor the results of peer review/performance improvement activities into the reappointment process, and Chapter Ten outlines the need to complete quarterly QI assessments, which includes peer review.
Due to the lack of specificity from HRSA relative to the number of reviews that are required, health centers should follow industry standard best practice, which is to complete a minimum of five charts per provider per quarter. It is extremely important to remember the number of reviews required to be completed by collaborating physicians for mid-level providers is often dictated by state-specific or payer guidelines, which is typically a percentage of face-to-face encounters. For example, one state may require the collaborating physician review 18% of a mid-level provider’s medical records, while another state may require the collaborating physician to review 10% of a mid-level provider’s medical records. As previously mentioned, the same situation applies to various payers.