In an external review, the review is conducted by a physical therapist outside of the facility, practice, or setting being reviewed. External peer reviews can be performed at the request of the facility, a payer, a medical review organization, a professional organization, or a regulatory agency and may result in a quality assurance review, determination of medical necessity or appropriateness of care, or determination of fair payment.
Today's health care system relies on documentation to measure patient outcomes, the need for services, and justification of the plan of care. Insufficient or absent documentation, over or underutilization of services, and inattention to proper coding can negatively affect reimbursement, communication among providers, risk management, and, most important, the care of the patient or client.
The resources on this page are intended to provide guidance on facets/areas of practice that can be assessed during an external peer review.