Delegates approve protocol for third-party telephone review.

Abstract

The Texas Medical Association Physician-Patient Advocacy Committee has conducted an extensive study of the telephone utilization review activities of private third-party payers and self-insured arrangements. Many of these organizations contract with private firms to conduct pre-certification and concurrent review of hospital admissions. These reviews often are accomplished by telephoning the attending physician's office. The procedures and criteria used by these firms and the qualifications of their review staff vary greatly. Physicians and their office staff are spending an increasing amount of time dealing with telephone utilization review. These review firms are not regulated or controlled by any agency. In response to the concerns expressed by physicians in dealing with telephone utilization review, Texas Medical Association's House of Delegates has approved the "Texas Medical Association Recommended Protocol for Physicians Responding to Private Third Party Telephone Review." The guidelines address concerns about confidentiality, physician documentation, patient advocacy, appeals, and cost and billing.