The Physicians Review Organization (PRO) provides objective case reviews when there is a question about the appropriateness of medical care or when providers are working to improve the quality of care. PRO is unique—each of our reviews is performed by a licensed, board-certified physician with the most up-to-date knowledge. With nearly 300 physicians serving as reviewers in 65 different specialties, this assures that each case review is both accurate and unbiased. Some of the most common reviews includes: 

Quality of Care Review

• Evaluate the adequacy of documentation

• Measure compliance against current care standards

• Identify areas of actual or potential quality concerns

• Provide recommendations for quality improvement, if indicated

Utilization of Service Review

• Evaluate medical necessity of service with consideration of severity of illness and intensity of service factors

• Evaluate rationale for alternative care settings

Individual Provider Review

• Evaluate adequacy of documentation

• Address areas of concern or questions identified by client

• Measure compliance against current care standards

• Provide recommendations for quality improvement and ongoing monitoring, if indicated

Other Services

• Recovery Audit Contract Appeal

• Adverse Benefit Determinations

For more information on how PRO can help your organization, please visit www.physiciansreview.org or contact us at (517) 336-1442 or Padmin@PhysiciansReview.Org.