Physician Post-Test

Welcome to your Physician Reviewer Post Test - IRO


IRO Background and Authority

1. Who is the accrediting entity for IRO Review?
2. What regulation guides URAC Accredited IRO review?

Goals/Purpose of Review

1. The types of cases subject to review include:
2. In order to ensure patients receive care that is medically necessary and of highest quality, all cases reviewed are assessed to determine:

Expectations/Roles and Responsibilities for Physician Reviewers

1. If the Physician Reviewer feels that the question posed in a case to be reviewed does not have a definitive “yes” or “no” answer, it is acceptable to note that in the review decision and rationale and not answer the yes/no question.
2. Which of the following is false?

Required Review Documentation

A Physician Reviewer can deny an admission that met the admission criteria as applied by the NPR.
Which of the following statements is true?
If the Physician Reviewer feels that there is information relevant to the case to be reviewed that was not included in the summary done by the Non Physician Reviewer, the Physician Reviewer should include that information in his/her review determination.
A case will not be assigned to a physician if the reviewer:
If during the course of your review of a case, you determine you have a conflict, complete the review and note the type of conflict in your summary.
HQSI’s Credentialing Program was developed to ensure only qualified professionals perform review. As part of the Credentialing Program, you are required to provide immediate notification within 3 business days of any change in board certification and/or license status.
Which of the following statements is false?
You are required to immediately report any incident where improper handling and/or disclosure of sensitive information may have occurred.
When performing electronic review off – site keep computer in a secure area when in use and not in use.

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