Are attending physicians given an opportunity to interact by phone with physician peer reviewers and supply additional information?
Yes. The physician reviewer will make one attempt to contact the attending physician to discuss the review before any adverse determination (medical necessity non-certification, confirmed quality of care issue, or DRG change) is made. The hospital or attending physician may request a reconsideration of an adverse determination. d) For physician review of child psychiatric cases, will there be a child psychiatrist available to review the cases? Child psychiatrists are among HSI’s physician peer reviewers. Every effort will be made to match the physician peer reviewer’s experience with that of the patients attending physician. e) Is there a penalty to physicians for non-medically necessary hospitalizations? No. The physician’s claim and the hospital’s claim are not linked. We will notify the attending physician when a review results in an adverse determination such as a medical necessity non-certification (denial). f) Does the hospital physician receive reimbursement if the case has non-
