...standards of health care; and (ili) Those services and items proposed to be provided on an inpatient basis could, consistent with the provision of appropriate...inpatient health care facility of a different type. (2) Section 1155(e) of the Act allows PSROs to use the services, and accept the findings, of hospital review...

...procedures are performed. A procedure may be medically necessary but denied if the PRO determines that it could, consistent with the provision of appropriate medical care, be effectively provided more economically on an outpatient basis or in an inpatient health care facility of a different type....

...procedures are performed. A procedure may be medically necessary but denied if the PRO determines that It could, consistent with the provision of appropriate medical care, be effectively provided more economically on an outpatient basis or in an inpatient health care facility of a different type....

...professionally recognized standards of health care ; and ''(C) in case such services and items are proposed to be provided in a hospital or other health...in, an inpatient health care facility of a different tvpe. "(2) Each Professional Standards Review Organization shall have the authority to determine, in...

...Meet professionally recognized standards of health care; and C. In the case of inpatient services, could, consistent with the provision of appropriate...inpatient health care facility of a different type. The decisions made by PSRO's with respect to these three issues are binding on Medicare intermediaries...

...provided to an Individual only when, to the extent, that the health care needs of such Individual cannot, consistent with the provision of appropriate medical...on an outpatient basis or more economically In an Inpatlent health care facility of a different type ; "(B) Costs of or charges for services by physicians...

...and services cannot, consistent with professionally recognized health care standards, effectively be provided on an outpatient basis or more economically...inpatient health care facility of a different type, as determined in the exercise of reasonable limits of professional discretion ; or " ' (F) to determine...

...such services cannot, consistent with professionally recognized health care standards, effectively be provided on an outpatient basis or more economically...inpatient health care facility of a different type, as determined in the exercise of reasonable limits of professional discretion. "DESIGNATION OF PROFESSIONAL...

...meets professionally recognized standards of health care; and "(C) in case such services and items are proposed to be provided in a hospital or other health care facility on an inpatienl basis, such services and items could, consistent with the provision of appropriate medical...

...individual basis. Section 1155(a) (1) (C) reads, as follows : "(C) in case such services and items are proposed to be provided in a hospital or other health...inpatient health care facility of a different type." "Appropriate" medical care could mean any one of several things. It could refer to that treatment which...