Peer Reviewers

From our Medical Director

By serving as a Peer Reviewer, you will be participating in improving the care for all patients, including your own. In the changing environment of health care, you appreciate that care can only be judged based on the documentation provided. The peer review process is very important. We are defining the "standard of care" for our medical community. This is not a task to be taken lightly. This review process has the potential to positively impact patients' lives and enhance our practice of healthcare.

KFMC's mission statement is simple: "Leading innovation to improve the quality, effectiveness and safety of healthcare." We strive to promote this mission by working with others in the healthcare community. Through providing high quality medical reviews and evidence based determinations, we will improve the healthcare provided to the patients in our communities and achieve our mission.

We appreciate your interest and look forward to working with you.

Jason Kimball, MD
Medical Director, KFMC

Qualifications of a Peer Reviewer

There are nine requirements an applicant must meet to be considered for placement on our Panel of Reviewers:

  1. Maintain Board Certification in the specialty for which they will review,
  2. Hold current, unrestricted license or certification as required for clinical practice in a state of the United States (KAR 40-4-42e(b)(3)),
  3. Physicians Reviewers must have a current certification by a recognized American medical specialty board (KAR 40-4-42e(b)(3)), if a specialty board exists,
  4. Must be actively providing direct patient care (KFMC),
  5. Have at least five years full-time equivalent experience providing direct clinical care to patients (FTE minimum of 37.5 hours per week),
  6. Have experience providing direct clinical care to patients within the past three years,
  7. Have "no history of disciplinary actions or sanctions, including loss of staff privileges or any participation restriction that has been taken or is pending by any hospital, governmental agency or unit, or regulatory body, that raises a substantial question as to the clinical peer reviewer's physical, mental or professional competence, or moral character." (KAR 40-4-42e(b)(4)),
  8. Completion and return of the Application to Review and attestations (KFMC),
  9. Must be approved as a Reviewer by the KFMC Medical Director or Credentialing Committee (KFMC).

At the time of application, additional self-reported information is provided by the applicant and includes, but is not limited to, basic identifying information such as name, address, contact sources, NPI, sub-specialties and the length of time providing direct patient care and dates indicating when the direct patient care occurred.

Additionally, PRs should:

  • Be reasonable and fair-minded.
  • Possess a good general understanding of the healthcare delivery environment and a commitment to quality.
  • Be willing and able to devote the time required.
  • Be flexible, willing to be called on short notice if necessary.
  • Possess excellent judgment.
  • Have the ability to keep things in perspective, look at the whole picture, and determine importance.
  • Have the finesse to provide constructive criticism.
  • Have the willingness to confront another physician when appropriate and necessary.
  • Be well respected as clinicians by their peers.
  • Provide educational feedback when appropriate.

Application

Please complete and submit the Peer Reviewer Application. If your credential is not an MD, DO, DPM, DOC or other physician, please complete the Health Care Professional Other than Physician (HCPOTP) Application.

Credentialing - We Verify our Peer Reviewers' Credentials

Credentials verification serves three functions:

  1. Initial credentialing is the evaluation of an individual's application for participation on the KFMC panel of Peer Reviewers (PRs).
  2. Re-credentialing/re-verification assesses the individual reviewer's qualifications for continued participation as a Reviewer.
  3. Ongoing monitoring of license and certification actions, as well as sanctions or disciplinary actions, assures that only those reviewers meeting the program requirements will provide review services.

Annually KFMC will verify your licensure within your area of practice. Every three years, KFMC will update self-reported information as in the initial application form and require new attestations. This will include a release of information related to your certification status.

Training

Training material is contained in the Peer Reviewer Orientation Manual. With your application, you will return an attestation indicating that you have reviewed and understand the document.

Please pay close attention to the training section titled "Roles and Responsibilities of a Peer Reviewer."

Credential Status Changes

Credential status changes will usually be captured in reports addressing licensure or certification status; however, some will be self-reported. Consistent with the policy of maintaining a panel of qualified reviewers, KFMC PRs must notify us within three business days of any adverse change in licensure or certification status. IR 3(a) Adverse changes include not only loss of a license or board certification, but also any sanction or disciplinary action related to their credentials and loss of hospital privileges or pending hospital action. Notice of an adverse change can be provided in any form i.e. written, phone call, fax.

An adverse change in licensure, certification, or sanction/disciplinary action is treated as any other piece of confidential information. Reviewers who are levied with an adverse change of this nature are considered out of compliance with qualifications to participate as a Reviewer with KFMC.

A copy of the form, Self-Reported Adverse Change in Licensure, Certification or Sanction and Disciplinary Action is provided with the application.

Reimbursement

Peer Reviewers are reimbursed at an hourly rate for the actual time reviewing a medical record. We must have a current W-9 for you on file.

Conflict of Interest

With your application to be a Peer Reviewer, you must complete and return a detailed Conflict of Interest form. If you have any questions regarding a potential or actual conflict of interest, do not hesitate to contact the Case Review Manager at KFMC -- 800-432-0770 ext 366.

If you become a Peer Reviewer, you will have to complete and return another Conflict of Interest attestation form with every case you review. This action is both a reminder and a confirmation that to your knowledge, you have no potential or actual conflict to provide an unbiased, professional review on each case in hand.

Some very basic Conflict of Interest examples would be:

  • Previous involvement in the case,
  • Association with the hospital at which the care was provided,
  • Prior conflict with the physician involved,
  • Affiliation with the physician involved in the care,
  • You are in economic competition with the physician involved.

For more information, call 800-432-0770, ext 366 or contact us by email.