PRO is a URAC-accredited, external review organization founded in 1983 by the Michigan State Medical Society (MSMS) and the Michigan Osteopathic Association. Since that time, PRO has become a separate organization but still maintain strong ties to MSMS, and our board of directors is almost entirely composed of physicians. 

The reviews are primarily of two types. Insurance companies usually ask utilization questions. For example, was the surgery medically necessary? Could the patient have been discharged a certain number of days earlier? Could this service have been provided on an outpatient basis? Hospitals generally ask quality questions. For example, was this case managed appropriately?

How much time commitment is involved? Each chart generally take one hour or less for the utilization issues and up to three hours for quality issues. The reviewer may specify how frequently charts may be sent or, if they are too busy to review a particular chart, it may be sent it back within 48 hours. Reviewers my also indicate a preference to only review a certain type of chart (utilization vs. hospital quality).

Here are the requirements to become a PRO reviewer. Reviewers must be board certified, involved in at least 20 hours/week of clinical practice, have a minimum of 5 years clinical experience, and have passed the credentialing process.

Upon receiving a record, PRO asks that each review is provided a thoughtful evaluation, write a concise summary of your findings, include specific rationale for the decision, and site references when able. Reviews are generally due in 10-14 days.

What do you get out of it? PRO reimburses medical reviewers starting at $125 per chart. In addition, by participating in this process physicians are helping set standards for your specialty. By helping keep standards high, this ensures that when an entity sends a case for review a qualified peer will review it.

We hope you will consider this opportunity to join the panel of peer reviewers of PRO. 

If you would like more information, please contact us at (517) 336-1442 or padmin@physiciansreview.org and we can discuss this further with you.