Comprehensive Medical Record Review
This is the most common type of review. The client receives a comprehensive, detailed report for each medical record with CIMRO’s peer reviewer’s (PR) findings, including evidence-based clinical guidelines and peer-reviewed literature, where appropriate.
External Peer Performance Evaluation (EPPE)
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EPPE is a retrospective evaluation of a sample of records containing fewer than 100 pages. This focused review uses a consistent set of questions regarding if the diagnosis, documentation, treatment, and follow up care were appropriate. An aggregate graphical report of the findings in a yes/no format is provided with the PR’s overall rating of care for each record. This allows for identification of practice patterns or areas or concern. No narrative responses are provided. At the client’s discretion, a second-level review or teleconference may be requested.
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Mentoring and Onsite Proctoring
The purpose of mentoring is to provide the involved practitioner with advice to improve handling of clinical decision making skills. Mentoring is carried out through remote means such as telephonic or visual communication (e.g. webcam) between the practitioner and CIMRO’s Mentor PR. CIMRO’s mentoring services will not involve any direct contact by the Mentor PR with the patient(s) discussed with the practitioner.
Onsite proctoring is accomplished through direct in-person observation to evaluate a practitioner’s competency to carry out actual clinical care and takes both cognitive and procedural abilities into account. For surgical observation and evaluation, CIMRO’s Proctor PR may be ‘gowned’ if circumstances dictate, but the PR would not ‘scrub in’.
CIMRO’s mentoring and proctoring results shall be used only in the course of the client’s internal quality control, peer review and/or for improving patient care, and shall not be deemed the provision of medical services.
Onsite proctoring is accomplished through direct in-person observation to evaluate a practitioner’s competency to carry out actual clinical care and takes both cognitive and procedural abilities into account. For surgical observation and evaluation, CIMRO’s Proctor PR may be ‘gowned’ if circumstances dictate, but the PR would not ‘scrub in’.
CIMRO’s mentoring and proctoring results shall be used only in the course of the client’s internal quality control, peer review and/or for improving patient care, and shall not be deemed the provision of medical services.
Fair Hearing
A fair hearing is an administrative hearing or a private medical review hearing held by hospital medical staff to resolve issues with a practitioner’s clinical privileges and medical staff membership. The fair hearing process follows the hospital’s By-Laws and is peer-review protected by the Health Care Quality Improvement Act (HCQIA) of 1986.
CIMRO’s PR is responsible for answering questions related to the clinical review of the cases, to discuss what the findings were and provide the rationale for the determination. Fair hearings may be conducted onsite at the facility or neutral office, or via video or teleconference. Typically all questions are posed by the hospital attorney, the involved practitioner’s attorney, and the hearing panel.
CIMRO’s PR is responsible for answering questions related to the clinical review of the cases, to discuss what the findings were and provide the rationale for the determination. Fair hearings may be conducted onsite at the facility or neutral office, or via video or teleconference. Typically all questions are posed by the hospital attorney, the involved practitioner’s attorney, and the hearing panel.
Other Consultative Services
CIMRO can provide review of new technology/procedure reviews, medical imaging/ radiology over reads, patterns of care, complex or highly specialized reviews, ambulatory/outpatient records, review of internal peer review or quality documents and assist with provider education. We will work with the client to define the scope of work and pricing.