Medical Loss Ratio: Updates and Impact

Healthcare spending is on the rise. The federal government has begun several initiatives to control costs, increase efficiency, and increase quality. Revisiting one of the ACA, Medical Loss Ratio.

Delegation For Workers Compensation

Across the country more and more workers compensation organizations are utilizing Workers Compensation Independent Medical Reviews to keep claims on track, and to decrease unnecessary expenditures as they relate to legal proceedings. When choosing an independent medical review network ask if they offer delegation for workers compensation medical reviews. Delegation provides an opportunity for significantly lower administration expenses wile increasing the quality of reviews.

External Review Best Practices: 3 Tips

As the ACA Repeal and Replace process sets a new course for healthcare, now is the time for reviewing a quick list of Health Plan Best Practices. The ACA mandated external review options for all consumers. Continuing this service to consumers sends a positive message about their health plan choice.

By | 2017-04-02T13:27:56+00:00 January 16th, 2017|Health Insurance, IRO, Uncategorized|0 Comments

5 Things to Look For in an Independent Review Organization Partner

Choosing an Independent Review Organization (IRO) for a meaningful partnership that drives improvement and cost savings can be a tough task. The importance of an IRO to help support effective decision making and give objective, unbiased reviews, can be crucial to your business. To ensure you choose an IRO that distinguishes itself through quality work, ongoing training, full compliance, and the latest technology, you’ll want to do your research. It’s very important to trust the organization you choose and you always want to make sure they are industry certified. The following is a 5 part checklist for selecting the right IRO Partner.

By | 2017-04-02T13:28:07+00:00 April 13th, 2016|Clinical Operations Improvement, Compliance, IRO, Physician Advisor/Peer Review|Comments Off on 5 Things to Look For in an Independent Review Organization Partner

Lunch & Learn: Join us for Workers Compensation: Keeping Claims on Track – a free webinar!

Would you like to learn how Workers' Compensation Organizations and Departments like yours are creating cost savings, improving efficiency, and decreasing claim costs? Join us Wednesday, April 13 at 12:00 PM EDT for a free lunch and learn event titled: Workers Compensation - Keeping Claims on Track. If you can’t make the event, don’t worry! Simply register for the web event to receive a recording of the event as well as a copy of the presentation after it is finished.

By | 2017-04-02T13:28:07+00:00 April 4th, 2016|IRO, News and Events, Quality Improvement Programs, Services, Webinar|Comments Off on Lunch & Learn: Join us for Workers Compensation: Keeping Claims on Track – a free webinar!

Workers Compensation Independent Medical Reviews: Keeping Claims on Track

workers compensation independent medical reviewsWorkers Compensation Independent Medical Reviews

Across the country more and more workers compensation organizations are utilizing Workers […]

By | 2017-04-02T13:28:08+00:00 January 4th, 2016|Health Care Reform, IRO, Physician Advisor/Peer Review|Comments Off on Workers Compensation Independent Medical Reviews: Keeping Claims on Track

3 Ways Independent Review Organizations Help Save You Money

We’ve been talking a lot lately about Independent Review Organizations and the appeals process that accompanies them. The role of the IRO in the appeals process is to provide an unbiased 3rd party opinion on complicated reviews, helping to assure that all reviews are given the time and care they deserve. It’s a common illusions in the healthcare industry that taking care of things in house is the best and easiest way to save money—however this isn’t true when it comes to claim reviews. If you are trying to manage your denials in-house, it can actually be counterproductive if you’re trying to save money and even time. Let’s take a look at how outsourcing your IROs can save you time and money.

By | 2017-04-02T13:28:09+00:00 December 3rd, 2015|Accountable Care Organizations, Clinical Operations Improvement, Compliance, Financial, Financial Analysis, IRO, Services, Webinar|Comments Off on 3 Ways Independent Review Organizations Help Save You Money

Outsourcing Your IRO: 3 Benefits of External IROs

There are times when we all can benefit from an outside perspective, in both life and in work. For healthcare, this outside perspective comes in the form of external Independent Review Organizations (IRO). An external IRO not only give perspective that differs from “insider” knowledge, but it’s also views situations in an entirely new light with set a quality set of standards and procedures. In some cases an external IRO may be required, but if not they are still a highly beneficial option. External IROs offer a unique perspective that is not only beneficial, but entirely necessary. Here are 3 reasons why outsourcing your IRO is a good idea.

By | 2017-04-02T13:28:09+00:00 November 23rd, 2015|IRO, Physician Advisor/Peer Review|Comments Off on Outsourcing Your IRO: 3 Benefits of External IROs

Do You Know What To Look For in an IRO?

Are you looking for an Independent Review Organization? Do you know what questions to ask and on what basis to compare? Not all Independent Review Organizations are equal. Independent Review Organizations (IROs) can be either internal or external. Independent are within the organization whereas external are completed by neutral third parties who are external to the organization.

By | 2017-04-02T13:28:09+00:00 November 20th, 2015|IRO, Physician Advisor/Peer Review|Comments Off on Do You Know What To Look For in an IRO?

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