peer review organization


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Related to peer review organization: Professional Review Organization

peer review organization

Professional review organization, qualilty improvement organization Managed care An independent or sponsored group of physicians or other appropriate peers–eg, allied health professionals who conduct pre-admission, continued stay, services reviews, for Medicare Pts by Medicare approved hospitals or physicians; PROs also review activities and records of particular health provider, institutions or groups. See Peer review.
References in periodicals archive ?
Medicare peer review organizations must now disclose the results of physician investigations to the beneficiaries who initiate complaints, a federal district court judge has ruled.
HCFA, through peer review organizations (PROs), will give hospitals State and regional summary information on the care given to Medicare patients with heart attacks.
MedReview, a subsidiary of the New York County Health Services Review Organization (NYCHSRO) which was established in 1974 as one of the first physicians' peer review organizations in the United States, provides its clients with guaranteed cost-effective case management and utilization analysis approaches that can assist them in developing or negotiating more cost-efficient benefit plan strategies.
Peer Review Organizations (PROs) were charged with monitoring reimbursement and had the power to sanction those who didn't comply.
NEC's initial areas of focus are closely aligned with several, more far-reaching initiatives highly applicable to health care providers, including the Centers for Medicare and Medicaid (CMS), state peer review organizations, the National Quality Forum (NQF) and Leapfrog.
June 21-25, involved continuing revisions in the Medicare physician payment reform (RBRVS), HIV infection among physicians, and recurring concerns over peer review organizations and Health Access America.
At the same time that professional standards review organizations, the precursors of peer review organizations, were pressing "peer review" for cost control reasons, another form of "peer review" was gaining momentum--review of medical care in connection with unsatisfied patients who filed malpractice suits.
The following year saw amendments to the Social Security Act that brought about prospective pricing by diagnosis-related groups (DRGs) and utilization review activities through peer review organizations (PROs).
To ensure Medicare pays correctly for medical services, the Health Care Financing Administration (HCFA) has approved Clementine, SPSS' enterprise-strength data mining workbench, for use within its national network of Peer Review Organizations (PROs), independent healthcare experts contracted by the federal government to improve the care given to Medicare patients.