Chapter 100-17 PEER REVIEWER

Rule 100-17-.01 Peer Reviewer

For purposes of this rule "Peer Reviewer" means any person rendering a professional chiropractic written or verbal opinion, which has the capacity or intent of affecting the frequency, duration, necessity, or outcome of chiropractic treatment or patient care and who is being compensated by a 3rd party payer or other contractual parties.

(2)

Chiropractic care shall include offering or rendering a professional chiropractic written or verbal opinion, which has the capacity or intent of affecting the frequency, duration, necessity, or outcome of chiropractic treatment or patient care. Any person practicing as a Peer Reviewer in Georgia must:

(a)	Notify the Georgia Board of Chiropractic Examiners of his/her intent to act as a Peer Reviewer. Such notification must include the individual's Georgia license number.

(b)	Possess a valid Georgia chiropractic license;

(c)	Have completed a certification program totaling a minimum of 100 hours in performing utilization peer review;

(d)	Have the physiotherapy modalities certification listed as a secondary license type on their Georgia license;

(e)	Identify themselves by name, degree designation, location of practice, and Georgia chiropractic license number;

(f)	Have established not less than five (5) years of active private clinical practice in Georgia immediately prior to rendering such opinion; and

(g)	Have earned a minimum of seventy percent (70%) of chiropractic related income from the active treatment of patients in Georgia in each of the previous five (5) years.

(3)	Licensed chiropractors conducting peer review on behalf of a Georgia professional association, as approved by the board by policy, are exempt from this rule.

(4)	Effective from the effective date of this rule amendment through January 31, 2010, the Board will consider requests from Georgia licensed doctors of chiropractic to be grand-fathered as Peer Reviewers.

Rule 100-17-.02 Guidelines for the Chiropractic Peer Reviewer

(1)	The chiropractic peer reviewer shall perform duties in accordance with the applicable law(s) and shall observe the highest of ethical and moral principles, evidence-influenced standards/guidelines and policies of professional practice.

(2)	The chiropractic peer reviewer shall make guidelines and supporting references available when requested.

(3)	The chiropractic peer reviewer understands that guidelines are not inflexible guidelines, and they should not be used as sole evidence for an absolute standard of care, and are considered on a case by case basis.

(4)	The chiropractic peer reviewer shall at all times act with integrity, truthfulness and honesty.

(5)	The chiropractic peer reviewer shall at no time divulge confidential information in an inappropriate or unlawful manner and shall exercise the care required for confidentiality and privacy consistent with the applicable legal jurisdiction.

(6)	The chiropractic peer reviewer shall not maliciously injure the reputation or professional practice of providers, employers, insurers, claimants, or other parties.

(7)	The chiropractic peer reviewer shall divulge and report appropriately when faced with potential conflicts of interest.

(8)	The chiropractic peer reviewer shall try to remain unbiased and objective, so that a trier of fact is served by accurate determination of the facts involved.

(9)	The chiropractic peer reviewer shall thoroughly review and analyze the evidence in a case, concerning the quality and efficiency of the services ordered or performed by the chiropractor under review.

(10)	The chiropractic peer reviewer shall not intentionally withhold or omit any findings or opinions discovered during a chiropractic evaluation or review that would cause the facts of a case to be misinterpreted or distorted.

(11)	The chiropractic peer reviewer shall never misrepresent credentials, education, training, experience, or membership status.

(12)	The chiropractic peer reviewer shall respect the rights of the examinee and other participants, and treat these individuals with dignity and professionalism.

(13)	The chiropractic peer reviewer shall never accept a fee for services which is dependent upon writing a report favorable to the referral service.

(14)	Any person rendering a chiropractic opinion in Georgia must identify themselves by name, degree designation, location of practice, and Georgia chiropractic license number.

(15)	The chiropractic peer reviewer shall continue to study, apply, and advance scientific knowledge, maintain a commitment to continuing sub-specialty education, obtain consultation, and use the talents of other healthcare professionals when indicated.

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