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Physician Peer Review

Utilization Review Services - Workers Compensation

Physician Peer Review

URAC Accredited Independent Review Organization

Physician Peer Review is an evidence-based review performed by an appropriately licensed medical professional to determine medical necessity of a proposed treatment or treatment that has already been provided. 

Peer Review is used to make a final judgement about quality of care in many quality assurance activities.   To overcome the low reliability of Peer Review, input from several reviewers is often recommended to point out overlooked information or allow for reconsideration of opinions and thus improve reliability.   Our team of medical and financial professionals partner with payers and legal firms to enhance their position to resolve complex billing and medical utilization disputes.

Overview

Physician peer reviews are quite common in Workers Compensation. Often these reviews which can be written and/or performed telephonically. These reviews involve one physician specialist reviewing the request of another physician specialist.

  • SFUR is a proven and affordable source of 3rd party medical Peer Reviews.
  • Rapid turnaround: Request 24 hours, 5 days, or 10 days.
  • Board certified specialist will testify at fair hearing on request.
  • URAC Accredited Independent Review Organization means client benefits from standards.
  • All reports are vetted by a medical knowledge reviewer and signed by reviewing physician specialist.
  • Best Prices of the Certified Independent Review Organizations.

Example

The most common peer reviews in Workers Compensation involve orthopedic surgery procedures.  SFUR orthopedic physician panelists have achieved a 68% success rate over the period of time from 2010 through 2019 in preventing unnecessary orthopedic surgery procedures after conducting peer reviews.

The average cost of an orthopedic surgery peer review is a fraction of the cost of the actual surgical procedures requested by the performing orthopedic surgeon.  SFUR’s 68% success rate in preventing unnecessary orthopedic surgeries that SFUR has experienced from 2010 through 2019, demonstrates that this small cost is a sound investment in preventing unnecessary care.

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