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Department of Health and Human Services Should Improve Monitoring of Professional Standards Review Organizations

HRD-81-26 Published: Dec 29, 1980. Publicly Released: Jan 12, 1981.
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Highlights

Professional Standards Review Organizations (PSRO) are designed to make sure that health care services provided under Medicare and Medicaid are delivered as effectively, efficiently, and economically as possible. GAO reviewed the records of acute care patients whose hospital stays were determined to be either partially or entirely medically unnecessary and not paid for by Medicare and Medicaid.

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services The Secretary of HHS should direct the Administrator of the Health Care Financing Administration to require that the periodic PSRO assessments and project officers' monitoring emphasize the extent that concurrent review activities comply with HHS coverage and procedural requirements, including (1) PSRO requirements and hospital practices for extending patients' hospital stays; (2) compatibility of PSRO and hospital certification procedures with the paying agents' payment procedures; (3) PSRO and hospital promptness in approving and denying extensions of patients' stays; and (4) PSRO monitoring of delegated hospitals.
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CompensationHealth care cost controlHealth care personnelHealth care servicesMedicaidOverpaymentsPlanningQuality controlMedicareHospitals