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ArticleUsing proactive external peer review to mitigate the risk of high-dollar lawsuits

Medical necessity investigations and lawsuits are a significant threat to healthcare providers, especially those that rely on internal medical staff peer review programs to identify adverse patterns in clinical behavior, according to the new brief Medical Necessity: Checks and Balances Most Hospitals Don’t Have, but Should.

The brief describes how to establish an effective medical necessity surveillance and accountability program. One key step includes creating an external peer review process, which is a best practice for hospitals looking to reduce risks related to medical necessity. Experienced external peer reviewers not only perform impartial assessments but also raise the red flag when self-reporting might be warranted.



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