Professional Standards Review Organization

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Professional Standards Review Organization

an organization established to monitor health care services paid for through Medicare, Medicaid, and Maternal and Child Health programs to assure that services provided are medically necessary, meet professional standards, and are provided in the most economic medically appropriate health care agency or institution.

The PSROs are an outcome of the Social Security Amendment of 1972 (Public Law 92-603), which requires the setting up of PSROs to monitor health care services paid for, wholly or in part, under provisions of the Social Security Act. Each PSRO serves a specific geographic area and develops or selects its own norms of care, diagnosis, and treatment. The norms are based on typical patterns of practice in the area being served, including typical lengths of stay for institutional care by age and diagnosis.

Professional Standards Review Organization (PSRO)

an organization formed under the U.S. Social Security Act Amendments of 1972 to review the services provided under Medicare, Medicaid, and Maternal Child Health programs. Review is conducted by physicians to ascertain the need for the program and to ensure that it is carried out in accord with certain criteria, norms, and standards and, in institutional situations, in a proper setting. The PSRO requires that regional organizations be formed to conduct these reviews throughout the nation.

Professional Standards Review Organization



Peer review at the local level required by Public Law 92-603 of the U.S. for the services provided under the Medicare, Medicaid, and maternal and child health programs funded by the federal government. The major goals of the PSRO program are as follows: to ensure that health care services are of acceptable professional quality; to ensure appropriate use of health care facilities at the most economical level consistent with professional standards; to identify lack of quality and overuse problems in health care and improve those conditions; to attempt to obtain voluntary correction of inappropriate or unnecessary practitioner and facility practices, and, if unable to do so, recommend sanctions against violators.
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