Does your review process protect against conflicts of interest?

Peer-to-Peer and Physician Advisory Review Programs are a crucial part of driving quality improvement throughout healthcare organizations. They are key to helping organizations maintain credibility and support effective unbiased reviews. Thanks to the Affordable Care Act, consumers expect unbiased review of their care through the claims and appeals processes. Independent Review Organization have now been placed in the forefront of the healthcare industry.

By | 2017-04-02T13:28:04+00:00 June 20th, 2016|Physician Advisor/Peer Review|0 Comments

5 Key Elements of the Peer Review Process

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.

By | 2017-04-02T13:28:09+00:00 November 12th, 2015|Clinical Operations Improvement, Physician Advisor/Peer Review, Training, URAC Accreditation, Utilization Management, Webinar|Comments Off on 5 Key Elements of the Peer Review Process

You Might Need an Independent Review Organization if…

Summary: An Independent Review Organization is designed to provide unbiased peer reviews in a manner that complies with all federal and state regulations, including those set forth by URAC Accreditation and the Affordable Care Act. We have all heard Jeff Foxworthy’s “You Might Be a Redneck if….” Some of his catch phrases include:

By | 2017-04-02T13:28:42+00:00 March 12th, 2014|Accreditation, Physician Advisor/Peer Review, Services|Comments Off on You Might Need an Independent Review Organization if…

Do You Need a New External Review Process?

- Part 1 - Do you need a new external review process? Under the terms of the Affordable Care Act (ACA), many group health plans and health insurance issuers may be required to revise their claims appeal and review processes in order to comply with the terms of this legislation.

By | 2017-04-02T13:28:44+00:00 February 20th, 2014|Health Care Reform, Physician Advisor/Peer Review, Services|Comments Off on Do You Need a New External Review Process?

Could We Make Healthcare Any More Confusing?

If you understand this infographic, you could work in Congress. In a nutshell, this infographic depicts the major departments and programs associated with regulating and administering healthcare and specifically Healthcare Reform or the Affordable Care Act.

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