Benjamin Franklin (quoting Daniel Defoe) famously declared that nothing is certain except death and taxes. For chiropractic physicians, the next most likely thing is a review by an insurance company or expert in a litigation matter. Doctors of chiropractic who actively practice are almost certain at some point to have their work reviewed for various purposes, such as insurance pre-authorizations, claim denials or post-payment audits, or for litigation-related issues.
Health care providers often wonder (but don’t always ask) what qualifications are required for persons who conduct reviews of physicians. It is a valid inquiry when someone is assessing the provider’s professional judgment. The short answer is that the requirements depend on the purpose and level of the review. The law requires different credentials for persons who conduct each stage of an insurance review, as well as for persons acting as experts in court cases.
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