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Peer Review

This section contains information about MDA's Peer Review System and is divided into two parts. The first portion provides a dentist's guide to the Peer Review Dental Care System, while the second portion explains the Peer Review.

Peer Review Dental Care System: A Guide for Dentists

What is peer review?
The Michigan Dental Association realizes that differences sometimes exist between the patient, dentist, or dental insurance carrier. The MDA Peer Review System is designed to assist patients, member dentists, and dental insurance companies in resolving disputes when they are unable to do so on their own.

A committee of your local (or specialty) peers will review cases on an impartial basis. Peer review may involve appropriateness of treatment, quality of treatment, questions of overall provider competency, dispute between provider and carrier over services rendered or to be rendered, and reasonableness of fees. Reasonableness and appropriateness of fee issues are reviewed directly by the MDA Committee on Peer Review/Dental Care (CPRV/DC).

The Peer Review System is one of the many benefits offered to MDA members. Members are obligated to participate in and cooperate with all MDA peer review entities.

Noncooperation or noncompliance will result in disciplinary action.

How is peer review helpful?
Peer review:

  • maintains high dental standards 
  • aids in mediation efforts 
  • meets the needs of the public regarding the quality and appropriateness of dental care 
  • assists parties in avoiding litigation, and 
  • helps member dentists with insurance disputes concerning quality and appropriateness of care issues. 

Who can initiate a peer review complaint?
A patient, member dentist, dental insurance company, or state agency may initiate a complaint.

How is a peer review complaint initiated?
The complainant obtains and completes a "Peer Review/Dental Care Information Form." Complaint forms are available by calling the Michigan Dental Association at (517) 372-9070; toll-free at (800) 589-2632.

How does peer review work?
Upon receipt of a completed complaint form, the matter is referred to the local or specialty dental society peer review committee. The committee will first attempt mediation by contacting both parties and clarifying the issue(s). If mediation is not possible, a formal review will take place. The parties are contacted for an interview, which can take place over the telephone or in person, depending on the nature of the complaint. The committee may perform a clinical exam of the patient, if one is warranted or appropriate. When the committee makes a decision, all parties are notified in writing.

The MDA monitors each case's progress at the local/specialty level.

Can the decision of the local/specialty peer review committee be appealed?
Yes. Any party may appeal the decision to the MDA CPRV/DC. The committee accepts appeals if proper procedures were not followed, and/or the decision contradicts the evidence presented.

What if a refund is due to the patient and/or insurance carrier?
A member dentist may refund the party(s) via the MDA escrow account, thus avoiding reportability to the National Practitioner Data Bank.

Is there a fee for peer review?
No. Peer Review is a free service provided by the MDA and the local/specialty dental societies. The members conducting reviews receive no remuneration for their services.

How much time will peer review take?
This is difficult to predict; it depends on the type of complaint and how cooperative all involved parties are. Also, the peer review system relies on volunteer dental reviewers. These volunteers are taking time out of their personal and professional lives to serve on the peer review committee.

Will the complaint and/or patient dental records be made public?
No. The complaint and contents of all case files are kept in strict confidence. Decisions of the MDA Peer Review System are confidential (MCLA §331.531, et. seq.). Neither dentist, nor patient is entitled to a copy of the complete case file.

What if the patient's complaint is against a nonmember dentist?
The peer review system is not available to nonmember dentists. If the complaint involves a nonmember, the complainant will be so informed and provided with a referral to the state of Michigan complaint and allegation division.

What if the complaint involves an out-of-state dentist?
If the treatment was rendered in another state, the complainant is referred to that state's dental association. If the treatment was rendered in Michigan and the dentist is an MDA member, peer review proceeds as though the doctor were in Michigan.

How does the peer review system operate if the patient now resides out-of-state?
The complaint is initiated as normal. If a clinical exam is required and the complainant cannot return to Michigan for the exam, the MDA will request assistance from the state dental association in which the complainant resides.

Does peer review allow waivers?
The MDA cannot compel the patient to sign a waiver as part of a decision.

If you would like to discuss the Michigan Dental Association Peer Review System, contact Grace DeShaw-Wilner, CAE, managing vice president of professional affairs, at (800) 589-2632, ext. 413.

Peer Review Ethics System: A Guide for MDA Members and the Public

What is peer review/ethics?
It is a system designed to uphold the Standards of Ethics and Code of Professional Conduct of both the Michigan Dental Association and American Dental Association.

Here's how the system works:

A committee of local dentists will review allegations of ethical violations on an impartial basis. The allegations may include false/misleading advertising, patient records, and criticism about another dentist's treatment.

There are many more areas that would fall under the scope of ethics, and reference should be made to the Michigan Dental Association Standards of Ethics and Code of Professional Conduct.

A copy can be obtained by contacting the Michigan Dental Association using the address listed below.

When can peer review/ethics be used?

  • to maintain high dental standards 
  • to assist in resolving disputes 
  • to enforce compliance with decisions of the Committee on Peer Review/Dental Care 

Who can initiate a peer review/ethics case?

  • patient vs. member dentist 
  • member dentist vs. member dentist 
  • component dental society vs. member dentist 
  • specialty dental society vs. member dentist 
  • general public vs. member dentist

 

How are peer review/ethics cases initiated?
Submit a letter of complaint to either your local component dental society or directly to:

Michigan Dental Association
Committee on Peer Review/Ethics
3657 Okemos Road, Suite 200
Okemos, MI 48864

After opening a case file, the MDA will refer the complaint to the appropriate component dental society in which the alleged violation took place. Mediation will be attempted, and, if unsuccessful, an informal meeting will be arranged to separately interview the principle parties. The component will decide whether a violation of the standards potentially exists and, if so, a formal hearing will ensue. If the committee decides that a potential violation does not exist, the case will be closed.

Can the decision of the local peer review/ethics committee be appealed?
If a sanction is imposed upon an MDA member by the ethics system, that member has the right to appeal to a higher level.

If the sanction is imposed by the component, the dentist may appeal to the Michigan Dental Association Committee on Peer Review/Ethics (MDA CPRVE).

If the sanction is imposed by the MDA CPRVE, the dentist may appeal to the ADA Council on Ethics, Bylaws and Judicial Affairs which is the final appellate body.

Will any records be made public?
No. The complaint and contents of all case files are kept in strict confidence. Decisions of the MDA Peer Review System are confidential (MCLA section 331.531, et. Seq.). Neither the member dentist, nor the patient is entitled to a copy of the complete case file.

Is there any cost for the services of peer review/ethics?
Peer Review/Ethics is a service provided at no charge by the MDA and your local dental society to ensure maintenance of the Association's Standards of Ethics.

What if the complaint is against a nonmember of the MDA?
MDA members must comply with a decision of the MDA Peer Review/Ethics System. The MDA Peer Review/Ethics System is not available to nonmembers. If your complaint is against a nonmember, you will be notified and referred to the Michigan Board of Dentistry.

To discuss the Michigan Dental Association Peer Review Ethics System, contact Grace DeShaw-Wilner, CAE, managing vice president of professional affairs, at ext. 413.



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