Ama Policy

Confidentiality and Utilization Review H-320.986

U.R. Criteria

(1) The AMA believes that: (a) in order to protect patient care and confidentiality, physicians should use judicious restraint when discussing any patient’s care over the telephone; and (b) physicians who receive patient permission for a case discussion by telephone from their patients on behalf of third party payers may, ethically and in their own best judgment, make a determination as to whether a reasonable charge for their time and expertise in providing such telephone case review discussions should be made, and that third party payers that demand such case reviews by telephone be encouraged to consider payment to physicians for their reasonable charges, if any, for these medical services. (2) The AMA objects to any utilization review performed solely upon the basis of an admitting diagnosis, without actual hospital record review, as being inadequate, incomplete and incapable of accuracy.

Policy Timeline

Res. 64, A-87 Reaffirmed: Sunset Report, I-97 Reaffirmation I-99 Reaffirmation A-07 Reaffirmed: CMS Rep. 01, A-17 Reaffirmation: A-18