The private organization that determines payment of Part B covered items and services is called a peer review organization (PRO).

Question

Quizplus · Accepted Answer

The organization that determines payment of Part B covered items and services is actually the Centers for Medicare & Medicaid Services (CMS). Peer Review Organizations (PROs) are entities hired by CMS to review the medical necessity, appropriateness, and quality of care provided to Medicare beneficiaries. They do not determine payment.

The Private Organization That Determines Payment of Part B Covered