nurse reviewer, Tampa, FL - May 18, 2016
The process begins when an electronic record is assigned to me. That record needs to be assessed for completion. Once verified is complete, the review begins by reading the record and identifying care that deviates from the national standards. Once that is completed, a written summary is sent to the Peer Physician Reviewer who determines whether or not that standard was met. During the day I may receive calls from Medicare beneficiaries inquiring about the results of the review. I write inquiring letters to the provider when is believed the standard of care may have not been met, or/and to provide them with results of the review. This description above may take more than a day, but it represents the type of activity I may encounter in a day.