A US federally mandated program to review the need, suitability, and quality of medical and surgical services provided to beneficiaries of the Medicare and Medicaid programs. It was established as a result of the Social Security Amendments of 1972 to promote the effective, efficient, and economical delivery of health care services of proper quality for which payment may be made under the Act. The amendments call for creation of local or statewide organizations of physicians to monitor services to ensure that the services conform to professional standards and are provided only when medically necessary and in the most economical and medically appropriate settings. Legislative and fiscal changes led to a name change of the program to Professional Review Organization in the late 1980s.
Subjects: Public Health and Epidemiology.