IPRO
IPRO, formerly known as the Island Peer Review Organization, 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, Albany, New York, Raleigh, North Carolina and affiliate offices in San Francisco, California.
The core business of IPRO include:
- Utilization review and quality assurance
- 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
IPRO acts as an End-Stage Renal Disease Network contractor, operating in New England as well as New York, and as a CMS support contractor working with all 18 ESRD Network teams nationwide as the ESRD National Coordinating Center.
IPRO produces and provides publicly reportable health care measurement and transparency data through its Pellucid data service. Pellucid data is used by public reports such as the Commonwealth Fund's WhyNotTheBest reporting tool and Illinois' Health Care Report Card.
IPRO acts as an External Quality Review Organization for Medicaid Managed Care in eight states and territories (New York, Pennsylvania, Rhode Island, New Jersey, Louisiana, Puerto Rico, Kentucky and Nebraska).
Brief history
- The Peer Review Improvement Act of 1982 (a part of the Tax Equity and Fiscal Responsibility Act of 1982) established Peer Review Organizations (PROs), replacing Professional Standards Review Organizations, which had provided services to the Medicare and Medicaid programs since 1972.
- In 1983, IPRO was incorporated as a peer review organization in New York area.
- 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 (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.