Review of a patient’s case by one or more physicians using federal guidelines to evaluate another physician in regard to the quality and efficiency of medical care. This is done to discover overutilization or misutilization of a plan’s benefits.
Tag: RAW
Peer review (Health Insurance)
A review of medical treatment, conducted by a medical staff with equal training to those who provided the care.
Peer review committee
See: peer review group.
Peer review group
Several local physicians who come together to solve insurance claim disputes and support ethical medical practices in the community. Sometimes referred to as a peer review committee .
Peer review organization (Health Insurance)
Physicians hired by the federal government to review the service provided to Medicare subscriber by the Medicare approved facilities.
peer review organization (PRO)
See: Quality Improvement Organization (QIO) program.