Peer review means an evaluation, based upon generally accepted standards, by a peer review committee established in KRS 312.200
or by other persons performing peer review pursuant to KRS 312.200(3)
, of the appropriateness, quality, utilization, and cost of chiropractic health care and health service provided to a patient.
Peer Review can be initiated by the patient, the patient's representative, insurer, or chiropractor.
Peer Review Committee
The KBCE Peer Review Committee is a committee of licensed chiropractors appointed by the Kentucky Board of Chiropractic Examiners to examine each inquiry submitted to it and report its findings to the Board and furnish copies of the findings to the patient, chiropractor, and third-party payor.
The findings of the Peer Review Committee on each inquiry reviewed may include a determination of whether or not the chiropractor properly utilized services and rendered or ordered appropriate treatment or services and whether or not the cost of the treatment was unconscionable.
The Peer Review Committee performs only "blind" reviews. All identifying information, of the patient and treating chiropractor must be sanitized before the cases are presented to the Committee for review.
Peer Review Committee Process
Once a claim has been submitted and the initial $50 fee has been paid, the claim will be reviewed by staff for completeness and appropriate sanitizing. The doctor will be notified via certified mail of the receipt of the claim and allowed ten (10) days to submit additional records and/or documentation. The complete case file, with all supporting documents, will be submitted to the Peer Review Committee members and the case will be assigned to a Primary Reviewer on a rotating basis. All committee members are expected to review every case and provide a case synopsis, unless they are the primary reviewer. The primary reviewer submits an evaluation of the review via e-mail for review by the full Committee. Once the full Committee has reviewed the case and made a final determination, upon receipt of additional fees required (from the requestor), the results of the findings will be submitted in writing to the Board of Chiropractic Examiners, the carrier, the patient and the health care provider.
Other Persons Performing Peer Review
Licensees properly registered with the Board to perform Peer Review are the only individuals that are allowed, by law, to perform peer/utilization review on any chiropractic claim.
Licensees desiring to register to perform Peer Review must initially have successfully completed a minimum of one hundred (100) hours of utilization review in independent medical examination from a chiropractic college accredited by the Council on Chiropractic Education; and for each year thereafter that a person seeks to register to perform peer review, he shall have completed six (6) hours in Kentucky of utilization review offered by a chiropractic college accredited by the Council on Chiropractic Education, in addition to the required annual education in KRS 312.175
. Persons performing review services according to KRS 312.200(3)
, shall annually register with the Board and pay a $50.00 registration fee, by June 1 of each year.
The Board does not register chiropractors to perform Independent Chiropractic Examinations. Any licensed chiropractor can perform an Independent Chiropractic Examination; however if the independent examination includes a review of the treating chiropractor’s records and treatment, that would constitute “Peer Review” and must be performed by a doctor on the Board's list of Registered PR Chiropractors