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・ Independent Local Radio
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Independent medical review
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Independent medical review : ウィキペディア英語版
Independent medical review

An Independent medical review is the process where physicians review medical cases in order to provide claims determinations for health insurance payers, workers compensation insurance payers or disability insurance payers. Peer review also is used in order to define the review of sentinel events in a hospital environment for quality management purposes such as to look at bad outcomes and determine whether or not there was any mis-diagnosis, mistreatment or any systemic problems involved which led to the sentinel event.
Physicians who perform independent medical reviews must be board certified and in active practice in that same area of treatment. These physicians are contracted by an independent review organization, medical management companies, third party administrators (TPAs) or utilization review companies to provide objective, unbiased determinations on what the root cause of the treatment was, whether or not there is medical necessity, if there was a sentinel event, what was the reason for it, etc.
==See also==

*Case management (USA health system)
*National Association of Independent Review Organizations
*Utilization management
*URAC
*Utilization review

抄文引用元・出典: フリー百科事典『 ウィキペディア(Wikipedia)
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