Physician Reviewer Selection/Qualifications

9130.1 – Physician Reviewer Selection/Qualifications (Rev. 24, Issued: 02-12-16, Effective: 03-14-16, Implementation: 03-14-16) The QIO should select a physician to review the case who is a specialist (actively practicing in his/her specialty and, whenever possible, board-certified) in either the specialty of the physician who attended the patient or the specialty indicated by the condition of the patient whose care is under review. Whenever possible, the physician reviewer should practice in a similar setting as that of the physician who attended the patient. Select a physician who agrees in writing to conduct the review in accordance with the requirements in §9130.2 and to testify as an expert witness, if necessary, to properly adjudicate the case. NOTE: A QIO is precluded from disclosing information that would identify a QIO physician reviewer without his/her consent (42 CFR 480.133(a)(2)(iii)). Therefore, the QIO must ensure that each physician reviewer is aware of the potential need to serve as expert witnesses and, prior to review of cases, secure a statement of willingness to serve as an expert witness to certify his/her availability for expert witness testimony. QIOs must maintain a file containing the names of physician reviewers. Upon request from OIG, QIOs must provide the names of individuals who reviewed specific medical records to serve as expert witnesses.