Physicians should be able to review performance rates befo...( onsideration by an independent externa...),Health

8. If the physician still contests a rating after all mechanisms for reconsideration have been exhausted, the physician should be permitted to include comments adjacent to the disputed rating in the public report.

9. Payers should provide a central source for collecting, monitoring, and analyzing all inquiries and requests for reconsideration in order to enhance accountability, ensure that concerns are adequately addressed, and improve processes through the identification of recurrent issues and concerns.

10. If the physician successfully challenges an erroneous rating, he/she should receive full payment from the third party payer. Any "withholds" that may have occurred from physician reimbursement during the period of appeal should be paid within sixty days to the physician along with interest based on the medical Consumer Price Index.

11. Recognizing the importance of educating physicians about the potential difficulty and associated expenses of a performance measurement auditing process, the College will educate its membership about the appeals process and encourage its membership to use it judiciously to avoid frivolous appeals. ACP is willing to engage in a multi-stakeholder process to promote an appeals process that is fair and reasonable for both physicians and health care payers.

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Contact: David Kinsman
dkinsman@acponline.org
202-261-4554
American College of Physicians
20-Apr-2007