Groups of doctors and other health-care experts paid by the federal government to check and improve upon the care provide to Medicare patients. Peer Review Organizations must review complaints concerning the quality of care given by hospitals, nursing homes, and home health care agencies.
An independent, state-based organization that uses local doctors and nurses to assess the quality of care provided to beneficiaries.
group paid by the federal government to review hospital treatment of Medicare patients. A patient has the right to appeal to a PRO if there is a question about care or length of stay.
A professionally sponsored and operated system, usually a physician-directed organization or program, for review of professional judgment about quality or appropriateness (medical necessity) of treatment; PROs arbitrate disagreements between physicians and other providers and third parties.
An organization established by the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) to review quality of care and appropriateness of admissions, readmissions and discharges for Medicare and Medicaid.
an organization in which practicing physicians assume responsibility for reviewing the propriety and quality of healthcare services provided under Medicare and Medicaid.
A federal program established by the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA), which monitors the medical necessity and quality of services provided to Medicare and Medicaid beneficiaries under the prospective payment reimbursement system. PROs also validate provider coding assignments that affect Medicare reimbursement.
an organization established by an amendment of the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA), to provide for the review of medical services furnished primarily in a hospital setting and/or in conjunction with care provided under the Medicare and Medicaid programs. In addition to their review and monitoring functions, these entities can invoke sanctions, penalties, or other corrective actions for noncompliance in organization standards.
A group of practicing doctors and other health care professionals under contract to the federal government to review the care provided to Medicare patients. Also known as a Quality Review Organization (QRO).
Groups of physicians who are paid by the federal government to conduct pre-admission, continued stay and services reviews provided to Medicare patients by Medicare approved hospitals.