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Other organizational practices may violate the peer review guidelines set forth 1988 by the ANA 1988. [11] The most frequent violation is the performance of direct care peer review by managers. One of the reasons for the confusion is that the ANA guidelines for peer review had been out of print prior to being reprinted and updated in 2011. [17]
As of 2015, CMS included the following health care practitioners under eligible providers: [4] Medicare providers (Physicians (Doctors of Medicine, Osteopathic Medicine), Podiatry, Optometry, Oral Surgery, Dentistry, and Chiropractic)
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.
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.
The PRISMA flow diagram, depicting the flow of information through the different phases of a systematic review. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) is an evidence-based minimum set of items aimed at helping scientific authors to report a wide array of systematic reviews and meta-analyses, primarily used to assess the benefits and harms of a health care ...
MeSH N05.700.350 – guidelines; MeSH N05.700.350.324 – codes of ethics; MeSH N05.700.350.650 – practice guidelines; MeSH N05.700.500 – medical audit; MeSH N05.700.500.200 – Commission on Professional and Hospital Activities; MeSH N05.700.520 – nursing audit; MeSH N05.700.675 – professional review organizations
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The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards.