Any serious discussion of patient care and cost containment must include a discussion about utilization review and management. Sometimes these two terms are used interchangeably, while their meanings and processes are quite different in reality.
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.
Telehealth services are becoming an increasingly popular option for patients across the US with over 10 million American utilizing some form of telehealth care. Telehealth spending is expected to hit $240 million by 2018¹. As the number of organizations providing telehealth services grows so do concerns surroudning quality of care, costs and compliance. URAC, one of the fastest growing health care accreditation agencies in the world, has launched a new telehealth accreditation.
Signed into law in 2015, the Medicare Access and CHIP Reauthorization Act (MACRA), centers on reimbursing providers for the value and quality of care they provide. The MACRA Quality Payment Program (QPP) is a proposed shift to the law itself and many healthcare organizations weighing-in.
Last week we introduced Gwen Roberts, SVP of BHM’s Consulting Division and discussed common questions that come up when organizations start the accreditation journey, focusing mainly on choosing between URAC and NCQA health plan accreditation. This week we are focusing on four key elements organizations should consider when deciding between healthcare accreditation bodies. Since many organizations have very diversified programs and levels, it’s important to understand the culture and expectation of your own organization first. Here are four helpful points that you can use as a guide as you begin your journey towards accreditation.
Lately we have been talking about the important of Independent Review Organizations (IROs) and peer reviews in the healthcare ecosystem. Today we continue this discussion and delve deep into the importance of the peer review process. We know that peer reviews are a crucial part of healthcare because they hold medical professionals and organizations accountable in addition helping to build a world of trust between patient and physician. The peer review process is one that consists of high levels of property technology and superior customer service. By boosting transparency in healthcare, peer reviews have become an essential standard helping to make healthcare safer and more efficient. So let’s take a look at the 5 core building blocks of the peer review process.
If you think you might need an Independent Review Organization to provide unbiased peer reviews in a manner that complies with all federal and state regulations, BHM can help. Last week we talked about the top 5 reasons you might need an external IRO but this week we’re focusing on the real-life situations that might lead to you to hire an IRO. If your answer to any of these questions is “yes," you may want to look into hiring an IRO.
While you are looking for an Independent Review Organization (IRO) it’s always important to select an IRO that distinguishes itself through quality work, ongoing training, full compliance, and the latest technology. The best way to ensure that the IRO you choose has the highest standards of practice and full compliance to federal rules and regulations is to choose a URAC accredited IRO. It’s important to trust the organization you choose and make sure they are industry certified, choosing an accredited IRO ensures that the IRO of your choosing is fully equipped to service your organization.
IROs and peer reviews an essential part of healthcare the healthcare ecosystem. Why? They help hold healthcare organizations and providers accountable in addition to providing key educational resources for learning as well as evaluation. A URAC accredited IRO “assures that organizations that facilitate independent medical peer review are free from conflicts of interest, establish qualifications for clinical reviewers, address medical necessity and experimental treatment issues, have reasonable time periods for standard and expedited reviews, and appeals processes.” The peer review process also adds transparency, which in turn helps build trust between patients and providers. Here are 5 reasons you need an Independent Review Organization (IRO).