Many payers and providers look to independent review organizations (IROs) as first-tier entities to gain efficiencies with decision-making and for an outside perspective on case documentation, utilization, and levels of care. So how do you know when it’s time to start working with an IRO? Let’s begin with a c
Checklist for Outsourcing Reviews
BHM recognizes the evaluation of outsourced services should be deliberate and extensive, which makes beginning the journey a little intimidating. This chart opens the conversation and focuses on the some of the top reasons our current clients contract with BHM for review services.
| Your Organization | BHM Healthcare Solutions | |
| $***,*** | Medical Director/CMO recruitment expenses | Higher job satisfaction/Less admin |
| Medical Necessity Criteria trained Network | Yes | |
| Conflict of Interest documentation on every case | Yes | |
| Case appropriate Behavioral Health sub-specialties | Industry Leader in BH |
Here are other considerations when evaluating a first-tier entity.
1. Managing peak workload
Working with an IRO means no part-time hiring or overtime hours for heavy work load periods. redirect the existing staff towards improving internal processes and patient care.
2. Reduced litigation risk
A 3rd party reviewer network provides an objective eye and detailed documentation. The reduction in risk is a byproduct of increased accuracy.
3. Specialized cases
You need a case reviewer who has the expansive knowledge of how to handle unique and specialized cases and is trained for this difficult role. When you rely on a single doctor or in-house review team they may struggle staying current on medical necessity criteria, policies, and updates while remaining focused on production. IROs provide expertise that comes from working daily in this arena.
4. Deadlines
If you’re tied to state and federal deadlines, an IRO can make sure you meet those regulations every single time. BHM’s extensive network spreads the workload seamlessly while maintaining the reviewer requirements and credentialing standards!
5. Revenue cycle
The hurdles and bottlenecks in many case revenue cycles melt away with the flexibility and efficiencies designed into BHM’s review processes.
