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Physician Reviewers

AFMC is expanding its Arkansas Medicaid peer review services, and we need your expertise. We’re looking for periodic physician reviewers in all specialties, especially cardiovascular surgery, psychology, orthopedics and oncology/hematology. Work at home on your own schedule and help make Arkansas’ health care system the best it can be. You determine the amount of time you want to spend on reviews — contact us to discuss remuneration. We offer fair compensation — and value your participation. If you are interested in becoming a physician reviewer, please visit our Physician Membership page.

Reviewers are needed for the following:

  • Prior authorization of surgical procedures, durable medical equipment and hyperalimentation
  • Review of inpatient services
  • Review of emergency services
  • Transplant review

Qualifications

  • Medical degree, state license and clinical experience in your specialty
  • Commitment to health care quality, service and integrity
  • Membership in AFMC

How reviews work

AFMC’s physician reviewers use the AFMC ReviewPoint portal along with Virtual Desktop Infrastructure (VDI) for all physician reviews. As a virtual desktop, VDI mimics an actual computer desktop via a safe, secure web page providing increased security for protected health information (PHI). This process is HIPAA compliant and provides a faster turnaround than paper or fax submissions. You can quickly request a reconsideration or monitor the real-time status of cases.

While there is a slight learning curve using the review software, the reviews themselves tend to be straightforward. Here is an example of a review that an AFMC physician reviewer handled in the past: “A five-year-old child was admitted with symptoms of nausea and vomiting for 24 hours. Vital signs were normal, and abdominal exam was reported as ‘soft, with no specific tenderness.’ Mucous membranes were dry, but skin turgor was good. BUN was 25, electrolytes were normal. Was acute care admission necessary for this child, or could a stay of less than 24 hours have been anticipated at the time of admission, allowing the care to be provided in an observation setting?"

Reviewer comment

“The patient had only minimal dehydration findings at the time of admission, with no indication of serious infection or an acute abdominal process. A stay of less than 24 hours should have been anticipated at the time of admission. Therefore, the observation setting should have been used to provide initial care. The patient was adequately improved by the next morning to allow discharge to outpatient management within a 24-hour period. Thus, this admission to acute care was not necessary and should be denied.”

To find out more, call Debbie Whitson at 479 573-7764​.

Appeals

Learn more about the Medicaid Fairness Act.

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