The Department of Veterans Affairs (VA) is the largest federal healthcare provider. Its peer review program is a critical element of quality management and demonstrates the VA’s commitment to providing the highest quality care possible for veterans. In 2019, the VA awarded iMPROve Health a multi-million-dollar peer review contract.
The Task at Hand
iMPROve Health conducts specialty clinical peer reviews on more than 100 patient-care cases monthly. We use the VA’s Electronic Health Record system and standardized reporting templates to complete each review. A reviewer of the same specialty studies the case and provides objective clinical expertise to determine if the care provided reflects established standards consistent with current literature and practice guidelines. Consistent with our URAC accreditation, we do extensive performance monitoring of our reviewers. The VA requires each reviewer to be fingerprinted and complete a background check.
The Value of Review Services
iMPROve Health has extensive experience reviewing various cases to evaluate the overall care and services provided. For example, during one review, an examination of claims data identified a provider billing for significantly more exams in a nursing facility than the provider’s peers of the same specialty. Accordingly, iMPROve Health selected a statistically valid sample of the provider’s billed cases over a specific period to determine the following:
- Were all the exams being performed?
- Were the extra exams medically necessary?
Contact Us
Please contact us for more information on iMPROve Health’s Review Services program.