If you are in the market for an Independent Review Organization (IRO) partner, looking for an IRO that is accredited is a great first step. Accreditation ensures that you receive the highest quality in service and support as well as an IRO who follow strict federal and state regulations. Accredited IROs must comply with important federal and state standards and timelines, ensuring you receive quality support that will help you create efficiencies for your peer review program.
While un-accredited IROs may follow strict guidelines and policies, Accredited IROs are dedicated to fairness and transparency in reviews and are held to rigorous quality standards. Often times accreditation status can be the difference between the highest quality service/support and bad services/issues.
Importance of Accredited IROs
Review Qualifications and Training:
The expert physicians who have been contracted by the IRO have met all of the required IRO guidelines. Reviewers are trained and certified, this ensures unbiased reviews are given and that the appreciate Medical Necessity Criteria are met. Accredited IROs ensure that reviewers selected for a case have specific qualifications and expertise relevant to the subject.
Mitigating Conflict of Interest:
Conflicts of interest can negatively impact reviews. Accredited IROs are required by URAC to guarantee there are no conflicts of interest between the reviewer and the claim. The law also ensures that IRO itself must have no conflicts of interest: “Neither the assigned independent review organization nor any clinical reviewer assigned by the independent organization may have a material professional, familial, or financial conflict of interest with any of the following that is the subject of the external review¹.”
BHM Healthcare Solutions offers URAC accredited IRO services with a state of the art peer review portal system, physicians licensed in every state and in almost every discipline, an option for both medical and behavioral health reviews, a dedicated peer review coordinator, and the desire to customize any of our processes to meet your specific needs.
The utilization of External Independent Review Organizations (IROs) is now a requirement in the new healthcare reform environment. Organizations which only use internal review departments may be not only increasing risk for their organization, but wasting valuable dollars through costly systems and infrastructure that do not make sense.