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Rehabilitation Medicine Consultant
Jeanne G. Doherty, MD

Assistant Medical Director
Director of Utilization Management
Clinical Assistant Professor, Department of Physical Medicine and Rehabilitation
Jefferson Medical College, Thomas Jefferson University

Jeanne G. Doherty, MD, serves as a clinical resource and consultant to hospitals, law firms, third party claim reviewing firms, workman's compensation panels, commercial insurers, healthcare organizations and other appropriate entities to perform prospective, concurrent and retrospective rehabilitation related case reviews to address: medical necessity; policy compliance; level of care; length of stay; resource management; hospital reimbursement; appropriate coding; all levels of appeal; disability.

DESCRIPTION OF SERVICES

As Director of Utilization Management, Assistant Medical Director and an experienced Physical Medicine and Rehabilitation Physician, Dr. Dougherty has expertise in prospective, concurrent and retrospective utilization, external and disability reviews. These reviews assist hospitals, law firms, third party claim reviewing firms, workman's compensation panels, commercial insurers and healthcare organizations determine coverage for certain treatments and procedures based on medical necessity, appropriate utilization of resources, level of care and disability, appropriateness of experimental/investigational treatments, appropriate coding, clinical interpretations of medical policy and contract language eligibility.

She also provides education to clinical staff and administration on documentation to support the timely, appropriate and cost effective delivery of rehabilitation services and to ensure compliance with hospital and CMS policy regarding inpatient rehabilitation admissions as well as the appropriateness of continued hospital stay.

Previous experience includes:

  • Physician reviewer for Medicare preadmission casesӔ to determine appropriateness of inpatient rehabilitation admission.
  • Expert consultant for external hospitals to review audited cases for appropriateness of admission and continued hospital stay.
  • Physician reviewer for multiple third party claim reviewing companies to determine appropriateness of level of care, recommended durable medical equipment and treatment including outpatient therapies.
  • Physician reviewer for multiple third party disability claim reviewing companies to determine appropriateness of short and long term disability benefits.
  • Leader of Magee's Audit Team.
  • Leader of comprehensive Documentation Improvement Initiatives implementing a number of changes including new processes and documents to achieve compliance with criteria for inpatient rehabilitation admission and continued stay including CMS Policy standards and industry criteria.
  • Leader in documentation review and appeal process (written and ALJ level) for Medicare audits, including recently extended Length of Stay Audit with 100% approval.
  • Leader in documentation review and appeal for Medicaid and Commercial Payer appeals with excellent outcomes. Overturn rate greater than 96%.

For more information, or to contact, call 215-587-3159.

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Professional Education Services

Designed to educate those in the rehabilitation community. Read more