Home Care and Hospice Care industry Definitions

Peer Review Organization (PRO)

A physician group or other professional medical
organization that assume responsibility for the review of the quality and
appropriateness of services covered by Medicare and Medicaid. PROs determine whether services are medically necessary, provided in accordance with professional standards, and in the case of institutional services, rendered in an appropriate setting. PROs must review a Skilled Nursing Facility's (SNF) care when a hospitalized
patient is discharged to the SNF and is readmitted to the hospital within 30 days, or a Medicare beneficiary complains to a PRO about a SNF's quality of care.