Individual who by training and experience has acquired special knowledge in a subject area (medical, dental, or other medical specialty) and is recognized by a peer group as an expert and provides professional advice or medical services on request.

1. Act of requesting advice from another physician or medical specialist about diagnosis or treatment of a patient. 2. In the Medicare program, services rendered by a physician (specialist, professional advisor, or qualified nonphysician practitioner) whose opinion or advice is requested by another physician, agency, or primary care provider in the evaluation or treatment of a patient’s illness or a suspected problem. The consultant reviews the history, does an examination of the patient, and provides a written opinion to the requesting physician. 3. In coding procedures, this is a type of service provided by a physician whose opinion or advice regarding evaluation and/or management of a specific medical problem is requested by another physician or other appropriate source. A physician consultant may initiate diagnostic and/or therapeutic services at the same or subsequent visit. The written or verbal request for a consult and the medical reason for it may be made by a physician or other appropriate source and documented in the patient’s medical record. The consultant’s opinion and any services that were ordered or performed must also be documented in the patient’s medical record and communicated by written report to the requesting physician or other appropriate source. Remember the 3R’s for documentation for both physicians: written or verbal request and medical reason , render opinion and document findings, and report to requesting physician. Also called medical consultation.

A physician who is paid a fee to examine and/or test a person for disability under either the SSDI or SSI program.

Registered nurse (RN) trained to assess medical problems by telephone and advise patients where to obtain medical care, as well as what treatment to do at home for symptoms.

Provider whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician. This may involve either examining the patient or the patient’s medical record.

In the area of health care, an individual who may receive medical services, such as a patient or a member of a managed care plan. Also called health care consumer.

Annual national survey that releases information on Medicare beneficiaries’ experiences and satisfaction with receiving care in managed care plans.