IPRO
Encyclopedia
Island Peer Review Organization (known as IPRO) is one of the federally designated Quality improvement organizations
in the United States. Headquartered in Lake Success
, New York
, IPRO has offices in New York City
and Albany, New York
.
The core business of IPRO include:
IPRO is now under contract with the U.S. Centers for Medicare and Medicaid Services
(CMS) to improve health care for people with Medicare in New York State. IPRO also holds major contracts with four U.S. State governments to assess and improve care for persons with Medicaid.
Quality improvement organizations
Quality Improvement Organizations monitor the appropriateness, effectiveness, and quality of care provided to Medicare beneficiaries. They are private contractor extensions of the federal government that work under the auspices of the U.S...
in the United States. Headquartered in Lake Success
Lake Success, New York
Lake Success is a village in Nassau County, New York in the United States. The population was 2,934 at the 2010 census.Lake Success is in the Town of North Hempstead on northwest Long Island. Lake Success was the temporary home of the United Nations from 1946 to 1951, occupying the headquarters of...
, New York
New York
New York is a state in the Northeastern region of the United States. It is the nation's third most populous state. New York is bordered by New Jersey and Pennsylvania to the south, and by Connecticut, Massachusetts and Vermont to the east...
, IPRO has offices in New York City
New York City
New York is the most populous city in the United States and the center of the New York Metropolitan Area, one of the most populous metropolitan areas in the world. New York exerts a significant impact upon global commerce, finance, media, art, fashion, research, technology, education, and...
and Albany, New York
Albany, New York
Albany is the capital city of the U.S. state of New York, the seat of Albany County, and the central city of New York's Capital District. Roughly north of New York City, Albany sits on the west bank of the Hudson River, about south of its confluence with the Mohawk River...
.
The core business of IPRO include:
- Utilization review and quality assuranceQuality AssuranceQuality assurance, or QA for short, is the systematic monitoring and evaluation of the various aspects of a project, service or facility to maximize the probability that minimum standards of quality are being attained by the production process...
- Quality improvement
- Data collection, abstraction and analysis
- Retrospective claims review
- Independent review of health plans' decisions to deny, reduce or terminate care
- Encounter data validation
- Healthcare Effectiveness Data and Information Set Compliance Audits
Brief history
- The Peer Review Improvement Act of 1982 (a part of the Tax Equity and Fiscal Responsibility Act of 1982Tax Equity and Fiscal Responsibility Act of 1982The Tax Equity and Fiscal Responsibility Act of 1982 , also known as TEFRA, was a United States federal law that rescinded some of the effects of the Kemp-Roth Act passed the year before. As a result of ongoing recession, a short-term fall in tax revenue generated concern over the budget deficit...
) established Peer Review Organizations (PROs), replacing Professional Standards Review Organizations, which had provided services to the MedicareMedicare (United States)Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
and MedicaidMedicaidMedicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...
programs since 1972. - In 1983, IPRO was incorporated as a peer review organization in New York areaNew York metropolitan areaThe New York metropolitan area, also known as Greater New York, or the Tri-State area, is the region that composes of New York City and the surrounding region...
. - In 1984, IPRO is designated the New York State Medicaid Review Agent and Medicare Review Subcontractor.
- In 1989, IPRO is awarded the New York contract for Medicare's 3rd Scope of Work.
IPRO is now under contract with the U.S. Centers for Medicare and Medicaid Services
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services , previously known as the Health Care Financing Administration , is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer...
(CMS) to improve health care for people with Medicare in New York State. IPRO also holds major contracts with four U.S. State governments to assess and improve care for persons with Medicaid.