Since the early years of Medicare, physicians have been reminded that Medicare is an insurance program, not a social program. Because social factors come into play in reviewing cases, the author finds himself wondering, "Is change needed? Would it help?"

Hospitalization↗

PubMed1993

New methodology challenges PRO.

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Hospital Administration↗

PubMed1993

Are PROs worth their costs?

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Centers for Medicare and Medicaid Services, U.S.↗

PubMed1992

KePRO's community outreach programs.

The Keystone Peer Review Organization board of directors and management have always taken pride in knowing that individually and as a group they have put forth extra effort to assure maximum efficiency and fairness in the review system. Another source of pride to the organization is our Community Outreach Program which we think is one of the finest and most progressive in the country. While such a program is required under our contract with the Health Care Financing Administration (HCFA), we saw the need to go beyond the HCFA requirements.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1992

Possible changes in store for PRO program.

Some drastic changes in the peer review organization (PRO) program have been proposed by the Health Care Financing Administration in recent months. Some of them are good, but, as we see them, some could cause problems for PROs, hospitals, and physicians.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1992

HCFA and the political scene.

Will the fact that this is a presidential election year affect the philosophy and direction of the Health Care Financing Administration as it relates to health care financing in general and the peer review organization program in particular? Perhaps.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1992

PRO myths vs. facts.

One thing of which the Keystone Peer Review Organization may be rightfully accused is that we are boastful about our efforts to communicate with physicians and providers. We think we do as good a job of education as can be done, and we don't mind saying so. However, certain myths have formed in the minds of some of our fellow physicians which seem impossible to dispel.

Humans↗

PubMed1992

Looking for changes in retroactive HCFA directives.

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Centers for Medicare and Medicaid Services, U.S.↗

PubMed1992

New guidance expands documentation requirements.

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Centers for Medicare and Medicaid Services, U.S.↗

PubMed1992

Who reviews the reviewers?

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Centers for Medicare and Medicaid Services, U.S.↗

PubMed1992

How does KePRO compare?

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Centers for Medicare and Medicaid Services, U.S.↗

PubMed1992

Update: Medicare patient records in physicians' offices.

We have become aware of a growing concern among physicians who are under the impression that review of Medicare patients' records in physicians' offices is imminent. Our current activity of reviewing care provided by health maintenance organizations (HMOs) may have caused some physicians to believe that such review had already started. HMO review may, at times, include a request for office records, but such requests are made to the HMO. The review does not take place at the physician's office.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1991

HCFA mandates new quality screens (more emphasis on histories and physicals and perioperative monitoring).

As standards of care are redefined based on new technology or new constructs of what constitutes quality, we can expect changes in the criteria by which our clinical activities are assessed. This is certainly true for peer review conducted under PRO programs, since the starting point for review is the application of criteria and screens. Review criteria are essentially developed by the PROs and, in Pennsylvania, with assistance of specialty society liaisons. The generic quality screens are HCFA-developed, and their use is mandated. Recently, all PROs received a Directed Change Order (DCO) in which newly revised outpatient generic quality screens were released.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1991

Surgical preapproval program ends.

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Professional Review Organizations↗