Alberta Medical Association

Alberta Medical Association

Committee Description

Committee Name

Peer Review Committee

Length of Term & Time Commitment Length of Term: Approximately 3 years ? The peer review process will likely continue past the end of the Amending Agreement (March 31, 2018).

Time Commitment: The Peer Review Committee will meet approximately once per month.

Note: Meetings will be in-person, and will commence in early 2017, as soon as the parties have identified their committee members.

Note: The AMA's Board of Directors appoints the AMA members of the Peer Review Committee.

Committee Description The new Amending Agreement provides for the development and implementation of a new AMA/AH Peer Review process to help encourage appropriate billing practices and complement AH's audit and compliance activities.

To carry out this work, a bipartite AH/AMA Peer Review Committee is being established which will report directly to the Management Committee (MC).

The Peer Review Committee will: ? Develop mechanisms for reviewing clinical appropriateness of Physician claims for Benefits and best billing practices. ? (AH will) Re-instate publication/distribution of non-identifying Physician billing profiles (with distribution of identifying physician billing profiles to individual physicians). ? Assist the AMA in distributing targeted billing education to members.

The Peer Review process may involve other activities, including developing further improvements to the AMA Fee Navigator, education efforts with AMA sections and other collateral activities, including:

? Analyzing patterns of billing to identify cases which are statistically outside of the norm. ? Educating physicians on appropriate patterns of practice and billing. ? Working with AMA sections and committees to define and clarify appropriate billing practices. ? Some monitoring of practice patterns, if deemed necessary. The committee has the authority to request a response to clarify or rectify a concern of the committee. If, on committee review, concerns are not adequately addressed, the committee has the ability to determine whether the information should be passed on to AH representatives who may decide to inform the compliance unit and request an audit.

The AMA is looking for 4 physicians to represent the AMA on the joint Peer Review Committee. The work of the committee will involve both the development of the peer review program, as well as ongoing implementation. Support for both phases will be provided by AMA Health Economics staff as well as AH Compliance Branch staff.

Required Skills and Experience

? Previous compensation committee experience within the AMA, preferably with one of the following: Fees Advisory Committee (FAC), Allocation Working Group (AWG), AMA's Compensation Committee (AMACC) , the Schedule of Medical Benefits Subcommittee (SOMBS), or as a Section Fees Representative.

? A good understanding of the Schedule of Medical Benefits ? fee codes, rules, modifiers, etc. as well as practice patterns of physicians.

? An understanding of the Amending Agreement and the effect that Peer Review decisions may have on physicians in Alberta.

? Knowledge of the profession and the ability to represent the views of the entire membership. ? Effective verbal communication and problem solving skills. ? Ability to work in a team environment and foster a collaborative atmosphere.

Benefits of Joining

? Opportunity to work closely with government to implement the recently ratified Amending Agreement.

? Opportunities to provide a high level of stewardship for and within the profession. ? Opportunities to help educate physicians regarding appropriate billing practices. ? Members receive honoraria and reimbursement of expenses incurred for meetings attended.

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