| Physician Reviewers |
 |
Become a Physician Advisor.
Thank you for your interest in becoming a Physician Reviewer for the South Dakota Foundation for Medical Care. Peer review for admission necessity, quality of care, DRG validation, EMTALA, BIPA, and Hospital Issued Notices of Noncoverage are examples of our case review obligations to CMS.
Eligibility Requirements.
A physician reviewer must be a doctor of medicine, osteopathy, dentistry, podiatry, or optometry, or another individual who is authorized under Federal or State law to practice medicine, surgery, osteopathy, dentistry, podiatry, or optometry. (See §1154(c), 42 CFR 476.1, and 42 CFR 476.98(a).)
Must either be engaged in active practice in South Dakota or be military physicians who actively practice in a military or VA health care facility in your State.
Active practice means that the physician usually practices (on a routine basis) a minimum of 20 hours per week.
Active practice must also include active staff privileges in a health care facility on a regular basis. (See 42 CFR 476.1.) Doctors of medicine, osteopathy, or dentistry must have active staff privileges in one or more hospitals in South Dakota. Note that emergency room physicians and dentists who do not have admitting privileges in an acute care hospital can meet the requirement of active staff privileges as it is defined in this regulation.
The goal is to match the physician reviewer’s variables:--licensure, specialty, and practice setting with that of the physician whose services are under review.
If you want to become a physician reviewer for South Dakota Foundation for Medical Care, or if you have additional questions, please contact Stephen Schroeder, M.D., Medical Director, SDFMC at 605-336-3505 or 800-658-2285. |
|
|
|
|
|
