Section 12.16.420. Conduct of peer review.

	(a)  A patient, patient's representative, insurer, or the patient's chiropractic physician may file a request for peer review with the board by submitting to the department  
		(1) a written request for review of the care provided, fees charged, or services rendered by a licensee to a patient;  
		(2) the peer review fee established in 12 AAC 02.150; and  
		(3) if the peer review committee requires a patient's treatment records for review, a completed release, on a form provided by the department, signed by the patient.  
	(b)  A licensee's acceptance of or request for payment for treatment given to a patient constitutes the licensee's consent to submit to the peer review committee the information required in (c) of this section.  
	(c)  A licensee involved in a case submitted to the peer review committee shall submit to the peer review committee all necessary records and other information concerning the patient's treatment.  
	(d)  The peer review committee shall conduct a peer review for each request for peer review submitted to it in accordance with guidelines established by the board. Except as provided in (f) of this section, the peer review committee shall report its findings to the board and furnish a copy of its findings to the patient, licensee, and third-party payor involved in the case.  
	(e)  The findings of the peer review committee must include a determination of whether the  
		(1) licensee provided or ordered appropriate treatment or services; and  
		(2) fees charged are a reasonable and appropriate cost of treatment; in determining the reasonableness and appropriateness of costs, the committee may consider, among other appropriate factors, charges by health care providers other than chiropractors for the same or similar services.  
	(f)  If the peer review committee determines that reasonable cause exists to believe the licensee has violated a provision of AS 08.20  or this chapter for which a licensee may be disciplined, the peer review committee may not report its finding to the board, but instead shall refer the matter to the department's investigative section. The peer review committee shall provide all information gathered in connection with the peer review to the department's investigative section.  
	(g)  Repealed 1/6/2002.  

Authorities

08.20.055;08.20.185

Notes

Authority

AS 08.20.055 AS 08.20.185 Editor's note: As of Register 161 (April 2002), the substance of former 12 AAC 16.420(g) appears in 12 AAC 16.990.

History

Eff. 2/21/97, Register 141; am 1/6/2002, Register 161; am 8/20/2004, Register 171; am 5/27/2006, Register 178

References

12.16.420;12.16.990