Peer Review
Process
The AMA’s 2016 Amending Agreement provided for the development and implementation of a new billing peer review process to help ensure appropriateness of fee-for-service claims. Through the Representative Forum, physicians have advocated for improving the accuracy and appropriateness of physician billing. This is seen as an important stewardship and leadership initiative. The AMA has formed its own internal Peer Review Committee with members appointed by the AMA Board of Directors.
- Read the December 15, 2017 President's Letter, "Launching Peer Review: Information and tools for physicians."
How does it work?
The PRC has access to and will be reviewing anonymized Alberta Health claims data. Through their analysis, the PRC will be able to develop education pieces and communicate them through a number of channels, including:
- the Billing Matters newsletter
- section consultations
- updates to the Fee Navigator®
- inclusion in AMA billing seminar content
The PRC’s focus is on billing issues and not on individual physicians. The objective is to educate and encourage appropriate billing, which could potentially encompass both over-billing as well as under-billing of services. Other steps may include making changes to the Schedule of Medical Benefits or recommending changes to Alberta Health’s claims system. The Amending Agreement references a specific target of $35M in the current fiscal year, and the PRC is keen to achieve those savings through education to avoid costs rather than through ramping up of Alberta Health audits.
- View the Peer Review summary document AMA Peer Review 101. This document describes the processes the PRC follows.
Provide input or ask questions
AMA members and sections can contact the PRC through email at peer.review@albertadoctors.org, or submit anonymous suggestions through the Peer Review Committee web portal. Please note that this is a place to identify billing issues and educational activities. Comments should be limited to billing issues and not identifying specific individuals. It requires an AMA log in, but physicians have the option to make their suggestions anonymous.
