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ERIC Number: ED225044
Record Type: Non-Journal
Publication Date: 1982-Aug
Pages: 15
Abstractor: N/A
Reference Count: N/A
Peer Review: The CHAMPUS Program.
Stricker, George
This paper examines the use of the peer review system in evaluating out-patient clinical services for a third-party payer seeking justification for payment of services. Peer review is defined as a process by which one professional, in an official capacity, makes a judgment about a co-professional in a matter involving professional functioning. The contracts between psychologists and psychiatrists and CHAMPUS (Civilian Health and Medical Program of the Uniformed Services), a health benefit program for retired military personnel and military dependents, are discussed. The review process is followed from the third-party payer request for an evaluation to disposition of the case. Similarities between the review systems implemented for CHAMPUS and the private insurance companies are reviewed, and the selection of reviewers is discussed. Criticisms of the project are noted, particularly regulations directed against the third-party payer, the mechanics of implementation of the system, accountability issues, and specific review criteria. Responses to these criticisms are cited, including criteria modifications, additional research, and a review of recommendations from the CHAMPUS National Advisory Panel. (JAC)
Publication Type: Reports - Descriptive; Speeches/Meeting Papers
Education Level: N/A
Audience: N/A
Language: English
Sponsor: N/A
Authoring Institution: N/A