Peer Review Services

Importance of External Peer Review Services

Welcome to our comprehensive guide on when and why external peer review services are necessary. From legal concerns to conflicts of interest, lack of internal expertise, and the need for credibility evaluation, we’ll explore the various scenarios where peer review services play a vital role. Discover different review types, including comprehensive, focused, OPPE/FPPE, medical necessity, and fair hearing support, all aimed at enhancing patient care quality and safety.

When External Peer Review is Necessary?


  • Legal concerns: When issues of physician, hospital or legal professional competence can potentially or actually be addressed in legal action.
  • Ambiguity: When a healthcare entity is faced with conflicting recommendations from internal reviewers or physician committees.
  • Lack of internal expertise: When no one in the organization has expertise in the specialty under review
  • Conflict of interest: When physicians within the organization are partners or associates of the physician under review
  • Lack of internal resources: When an organization wishes to perform a larger study involving many patient records.
  • Credibility: when an organization needs to evaluate internal review processes.
  • Miscellaneous needs: When a medical staff needs an expert witness for a fair hearing, for evaluation of a credentials file, or for help in with quality improvement initiatives.

Review Types

Comprehensive Reviews:

Comprehensive physician peer review is a process in which a physician’s clinical performance, medical decisions, and adherence to professional standards are evaluated by their peers, other physicians within the same specialty. This type of review is designed to promote quality improvement, enhance patient safety, and maintain high standards of care within healthcare organizations. QPS offers narrative external peer review reports, which provide an in-depth evaluation of practitioner performance on a specific case or group of cases.  Elements of the review include a Summary of the Clinical Course, answers to client questions, and complete rationales for each determination.

Focused Reviews:

Focused physician peer review typically targets specific aspects of a physician’s practice rather than evaluating their overall clinical performance. This type of peer review is often conducted in response to a particular concern or issue related to a physician’s practice. These reviews consist of scored summaries of individual cases using a standard numerical rating system.  Cases are evaluated against specialty-specific criteria and tabulated and presented in a Physician Peer Review Summary, which is in spreadsheet format. For programs involving multiple practitioners, a Group Evaluation Summary is provided. No narrative responses are provided.

OPPE/FPPE Reviews:

Ongoing physician practice evaluation (OPPE) and focused physician practice evaluation (FPPE) are standard protocols that healthcare organizations must follow at the established intervals. All hospitals and healthcare organizations evaluate providers’ performance and competence based on their bylaws and regulatory body’s standards. Creating and maintaining an effective FPPE and OPPE programs is essential to allow providers to improve. QPS supports healthcare organizations by providing reliable, objective reviews to evaluate quality, safety, and/or appropriateness of provider’s care.

Medical Necessity Reviews:

Medical necessity reviews are conducted to determine whether a proposed medical treatment, procedure, or service is appropriate and essential for a patient’s diagnosis or condition. These reviews help ensure that healthcare resources are used efficiently and that patients receive the most appropriate care based on established medical criteria. QPS support healthcare organizations and insurance companies to evaluate whether the proposed healthcare service is medically justified and meets the criteria for coverage or reimbursement.

Fair Hearing support:

Fair hearing refers to an administrative hearing in a hospital or professional association. The Fair Hearing process is coordinated by the hospital medical staff and aims to provide due process when it comes to the provider’s privileges and medical staff membership. Quality Peer Solutions can support the process by providing a clinical review of cases, discussing the evidence-based standards of care, and by providing expert witnesses or consultants when needed.


Contact Us

Whether you’re a physician, hospital or legal professional , or insurance company, contact us so we can get you setup with an account to facilitate secure transfer of medical records.


File Assignment

Your file will be assigned to a qualified and vetted Reviewer. Upon completion, your file with findings will be made available to you through HIPPA compliant file transfers.



You’ll review your files for completion and clarity. If satisifed, we complete the transaction. If something’s missing, your Case Manager will help resolve any issues.



With the files now complete and with no further action needed, we will close the case. The payment is due within 30 days of your case’s completion. If you have questions on payment, call us.

Want to discuss your case?

Call +1 (844) 733-7738 or complete the Contact form below.

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