36C10X19Q0200-019.pdf

Criteria for Inter‐Rater Reliability (IRR) Study

1) Include all panel members

2) Will include time frames.

3) Including what benchmarks are:

a. Passing

b. Failing

c. Require Remediation

4) What constitutes remediation

5) When will reassessments occur for those reviewers that do not pass the IRR

6) When will a provider be removed from the panel

Potential Example of Study

This method is continuous. A Point system is implemented for each reviewer. A point is earned by a reviewer for:

1) Each 2 Level discordance (PRC level 1: Reviewer level 3 or PRC level 3; Reviewer level 1)

2) Each Facility/VISN/VACO concern of inappropriate review

When 3 points are earned, VENDOR Medical Director will assess those cases. If the Medical Director agrees with the reviewer, 0 marks given. If the Medical Direct disagrees with the reviewer’s assessment

1 mark is given. If there are 2 marks, the reviewer has failed the IRR, and will need remediation.

Reassessment will occur each time 3 points are earned by a reviewer. If a reviewer is remediated 2 times within a rolling 12 months, that reviewer will be considered for removal from the panel.