A physician sponsored organization charged with comprehensive and ongoing review of services provided under medicare, medicaid, and maternal and child health programs. The object of this review is to determine for purposes of reimbursement under these programs whether services are medically necessary; are provided in accordance with professional criteria, norms, and standards; and, in the case of institutional services, are rendered in appropriate settings.
Established by the U.S. Federal Government in 1972 as part of the Social Security Amendments; designed to review the need, feasibility, and quality of medical and surgical services provided by the Medicare and Medicaid programs. Its name was changed to the Professional Review Organization in the late 1980s Utilization Review Committee.
A physician-sponsored organization charged with comprehensive and ongoing review of services provided under the Medicare, Medicaid and Maternal and Child Health programs. The purpose of this review is to determine for purpose of reimbursement under these programs whether service are: medically necessary; provided in accordance with professional criteria, lurins and standards: and, in the case of institutional services, rendered in an appropriate setting. The requirement for the establishment of PSROs was added by the Social Security Amendments of 1972, to the Social Security Act as part B of title areas have been designated throughout the country and organizations in many of these areas are at various stages of implementing the required review functions.
An organization established under federal law to review medical necessity, appropriateness, and quality of services provided to beneficiaries of the Medicare, Medicaid, and maternal and child health (MCH) programs. These organizations were physician-sponsored. They have now been replaced in function by Peer Review Organizations (PROs) under the current federal program for the administration of Medicare.
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.