Kentucky Administrative Regulations
Title 201 - GENERAL GOVERNMENT CABINET
Chapter 21 - Board of Chiropractic Examiners
Section 201 KAR 21:075 - Peer review committee procedures and fees
Universal Citation: 201 KY Admin Regs Service 21:075
Current through Register Vol. 50, No. 9, March 1, 2024
RELATES TO: KRS 312.200
NECESSITY, FUNCTION, AND CONFORMITY: KRS 312.200 requires the board to appoint a peer review committee and establish procedures and fees for the review of submitted claims. This administrative regulation establishes fees and procedures pertaining to the peer review committee.
Section 1. Peer Review Committee.
(1)
The board shall appoint a Peer Review committee of up to five (5) members. All
members of the peer review committee may serve a three (3) year term.
(a) Each member of the Peer Review committee
shall serve until their successor is appointed and qualified.
(b) Appointments to fill vacancies shall be
for the unexpired term.
(c)
Applicants for appointment to the Peer Review committee shall make application
on the same form utilized by applicants for appointment to the board, except
filed with the board and not the Governor's office, and shall include a cover
letter stating that the application is for the Peer Review
Committee.
(2) Members of
the Peer Review committee shall be doctors of chiropractic of integrity and
ability who at the time of their appointment have been actual residents of the
Commonwealth of Kentucky for at least two (2) years next preceding their
appointment, and have been engaged in the actual practice of chiropractic for
at least five (5) years next preceding their appointment.
(3) Any member of the peer review committee
shall not hold an elected position in any state organization or association
relating to or consisting of licensees of this board or the practice of
chiropractic.
(4)
(a) Beginning on March 1, 2021, the
longest-serving member on the Peer Review committee shall be replaced by a
member with a three (3) year appointment.
(b) In 2022, the next longest-serving member
of the Peer Review committee shall be replaced by a member with a three (3)
year appointment.
(c) In 2023, the
next longest-serving member on the Peer Review committee shall be replaced by a
member with a three (3) year appointment.
(d) In 2024, the next longest-serving member
shall be replaced by a member with a three-year appointment.
(e) Thereafter, each appointee to the Peer
Review committee shall be appointed to a three (3) year term.
(f) This subsection shall not prohibit any
member of the peer review committee from serving consecutive
terms.
Section 2. Procedures and Fees of Peer Review Committee.
(1) Peer review shall not take place until
the patient has submitted a release permitting photocopies of the applicable
treatment or billing records prepared by the chiropractor in the regular course
of business.
(a) Treatment records shall not
be released for peer review without the patient's authorization.
(b) The acceptance of, or the request for,
payment by a chiropractor shall constitute the consent of the chiropractor to
the submission of all necessary records and other information concerning the
treatment or the cost to the peer review committee.
(2)
(a)
Each claim shall be assigned to an individual member of the committee who shall
review the submitted records and response from the charged party and report his
findings to the full committee, which shall review the findings and either
adopt those findings or modify them as determined by majority vote.
(b) A copy of the findings shall be forwarded
to the board, the patient, the chiropractor, and insurer or other third party
payor.
(3)
(a) The peer review committee shall elect a
chair.
(b) The committee may
recommend for the board's approval a contract with or employment of third
parties to perform administrative functions or to aid in obtaining records
necessary for appropriate review of claims.
(c)
1. The
peer review committee shall recommend to the board that a complaint be filed
against a chiropractor if it appears from the review of a claim that reasonable
cause exists to believe that the chiropractor has violated any portion of KRS
Chapter 312 or 201 KAR Chapter 21 for which a chiropractor may be
disciplined.
2. The peer review
committee shall transmit all complaint information the committee possesses to
the board.
(4)
(a) A chiropractor, insurer, or other third
party payor requesting review shall submit with the request a service fee of
fifty (50) dollars payable to "B.C.E. Peer Review."
(b) An additional fee shall be charged for
claims requiring more than one (1) hour of review by the committee calculated
at fifty (50) dollars per hour, which sum shall be due prior to the delivery of
committee findings to all parties.
(c) All fees shall be paid by the
chiropractor, insurer, or other third party payor requesting the
review.
(5) Each member
of the peer review committee shall comply with the requirements and standards
established in
201 KAR
21:095.
Section 3. Annual Report.
(1) An annual summary of the findings of the
peer review committee shall be prepared by the committee and submitted to the
board.
(2) The report shall be made
available to interested persons upon request and upon payment of the cost of
reproduction.
(3) A report or
summary submitted to the public by the board shall not disclose the name or
identity of any patient without the patient's consent.
STATUTORY AUTHORITY: KRS 312.015, 312.019, 312.200
Disclaimer: These regulations may not be the most recent version. Kentucky may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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