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Clinical peer review, also known as medical peer review is the process by which health care professionals, including those in nursing and pharmacy, evaluate each other's clinical performance. [1] [2] A discipline-specific process may be referenced accordingly (e.g., physician peer review, nursing peer review).
These guidelines are required by a US statute enacted in 2001 called the Data Quality Act and also known as the Information Quality Act ("IQA"). OMB states that it prepared the peer review Bulletin pursuant to OMB's authority under the IQA. The peer review Bulletin provides detailed guidelines for peer review of influential scientific information.
An independent medical review (IMR) is the process where physicians review medical cases in order to provide claims determinations for health insurance payers, workers compensation insurance payers or disability insurance payers. Peer review also is used in order to define the review of sentinel events in a hospital environment for quality ...
In 2015 CMS identified 254 quality measures for which providers may choose to submit data. The measures map to U.S. National Quality Standard (NQS) health care quality domains: [4]
The Office of the Assistant Secretary for Planning and Evaluation (ASPE) is the principal advisory group to the United States Secretary of the Department of Health and Human Services (HHS) on policy development and provides coordination and support for HHS's strategic and policy planning, planning and development of legislation, program evaluation, data gathering, policy-related research, and ...
In California, this move was echoed as insurance agencies and health plans were enabled to perform "peer review." This combination of events ended the ability of physicians to conduct peer review of themselves, and "peer review" of physicians became transformed into "performance appraisal" done by physicians and non-physicians alike.
President Donald Trump signed an executive order Tuesday to end federal support for medical procedures aimed at altering sex or gender that involve surgical interventions or the use of puberty ...
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines.