AHA Coding Clinic® for ICD-9 - 1984 September - October
AHA Monitoring PRO Implementation
by Betty Fuchs, staff specialist, Division of Quality Control Management and Tom Granatir, staff specialist, Office of Public Policy Analysis, American Hospital Association The American Hospital Association has been working with state hospital associations to develop a mechanism for collecting information on the implementation of the peer review organization (PRO) program. Interested state hospital associations will be surveying their member hospitals, using a set of basic data elements developed by the AHA, to assess the following two aspects of PRO implementation: The process of negotiating hospital-PRO agreements for Medicare review The actual impact on hospitals of medical review policies...
Subscribe or sign in to view the full article.
Article Overview
This article explains an American Hospital Association initiative to collect state-level information on peer review organization implementation. It covers how hospitals are being surveyed, what types of review experience and administrative impacts are being tracked, and how the resulting information may support hospital association advocacy and liaison work. The content is relevant to hospital administrators, medical record professionals, and coding/compliance staff interested in Medicare review oversight and program monitoring.
Why This Topic Matters
It helps readers understand the kinds of operational and coding-related issues hospitals were being asked to document under PRO review and how state associations planned to use the collected data for broader policy efforts.
Article Sections
-
Hospital-PRO Agreement Monitoring
This section outlines the planned survey approach for gathering information about hospital and PRO interactions during agreement development. It focuses on the administrative process and the types of response data being collected.
-
Monitoring Review Experience
This section describes ongoing collection of hospital experience under PRO review. It covers review volume, denials, reconsiderations, compliance activity, and other broad operational measures.
-
Liaison Activities
This section discusses coordination among hospital associations, medical record organizations, and hospital personnel. It also notes broader efforts to identify implementation difficulties and support communication about the review system.
What You Will Learn
- How state hospital associations were expected to gather information on PRO implementation
- What categories of hospital review activity were being monitored
- How association-level data were intended to support broader advocacy and reporting
- Which organizations were involved in liaison and monitoring efforts
Who Should Read This
- Hospital administrators
- Medical record professionals
- Compliance staff
- Health policy analysts
- Coding and reimbursement staff
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com