Medicare Review Services and Programs

The review department of AFMC is made up of review coordinators (nurses and health information management professionals), physicians, and clerical support staff. Twenty review coordinators are located in the Fort Smith office and perform a variety of review functions. Eighteen review coordinators live in cities and towns around the state, and perform reviews in hospitals in their region of the state.

The review department of AFMC performs a variety of prior authorization and retrospective reviews for Medicare, Medicaid and private insurance companies. The initial screening review is performed by a review coordinator. If the review coordinator cannot approve an admission, length of stay or procedure, the case is referred to a physician advisor. Only a physician may make the decision to deny coverage of an admission, length of stay, or procedure.

The screening criteria used by the review coordinator is available to all Arkansas medical providers. This criteria is a screening tool only and is not used by the AFMC physician advisors when making review determinations.