How I prepare my Peer-To-Peer notes as a physician advisor prior to talking to insurance Medical Director

How do you prepare before doing Peer to Peer with an insurance medical director?

Did you prepare any SmartPhrase for helping with Peer to Peer review preparation on EPIC EMR?

I have been working as a physician advisor for a few years now. Through the years, I have been trying to find a way to quickly prepare for peer to peer reviews. Lot of denials come daily while working as a physician advisor.

Each peer to peer review takes a lot of time. This is the most time-consuming part on a day to day work for a physician advisor. I work on both EPIC EMR and CERNER EMR currently.

EPIC EMR:

I was always looking at some type of tool to make this process easier. I could not find one so far. I somehow gathered the following smart texts and smart links and made the following smart phrase to help me save me some time while preparing for peer to peer review while working on EPIC EMR.

The above smartphrase brings up multiple things for me to quickly get a good idea about the patient, for example, patient name, age, BMI, chief complaint, active problem list, past medical history, any surgery if done, labs including CBC, BMP, LFTs, Troponin, Prob BNP, culture results, imaging studies, discharge medications etc.

I open an ancillary note, use the above phrase and bring up all the above mentioned info.

After that, I just go to Notes section, start from the first note all the way down and review one after the other from admission day to the discharge day. Review the flowsheet for all the vitals, graph the BP, Oxygen flow rate, Temp, Heart rate if there are any severely low or high values.

The above process pretty much gives me all the info needed for me to do a peer to peer review on EPIC EMR.

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CERNER EMR:

Similarly, I made an attempt to make an AUTOTEXT on CERNER EMR. I made the following.

As you can see, this autotext pulls up patient’s Acuity, Gender, Name, age, chief complaint, Diagnoses, surgeries, last 3 sets of vitals, lab results, medications, input/output data, antibiotics, discharge info etc.

To the above patient’s info that comes up upon using Autotext above, you can add daily events and prepare for peer to peer review.

Please share if you developed anything like this so I can follow and improve this process and save time in the process.

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