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.
1. The Unbiased Opinion
Working with an IRO removes the possibility that a conflict of interest might arise, as IROs are required to sign documents verifying that no conflict of interest exists. This ensures that each patient gets the same, uninfluenced decision made by a completely uninterested party. IROs provide this perspective by weighing both sides of healthcare decisions, with the help of multiple specialist physicians who can provide unbiased reviews of a particular organization’s situation. If you think about how payers need IROs to review their coverage of services, physicians, patients, and hospitals need IROs to review trouble spots on a case-by-case basis and evaluate the documentation.
Expert physicians with a wide breadth of experience and a variety of specialties and sub-specialties are available look at patient records and assist IROs with identifying problem areas that may be causing the delay in payment from insurers. In certain cases these experts might be able to provide objective insight that someone in-house would be unable to provide. Let’s break it down with an example: If you had a medical necessity case and needed an expert to make the call, would you have someone you’d trust to make that decision (and have it stand up in court, if necessary?) IROs relieve that pressure and act as a third party so you don’t have to worry.
3. Strict Policies and Procedures
Since external IROs must adherence to federal and state guidelines, it’s required that all reviews are conducted in a standardized, timely fashion. The efficient nature of external IROs allows you to be sure that the hard work put in on your end will be reciprocated by the reviewers. You can rest assured that because external IROs must comply with state and federal mandates for appeals and medical necessity denials, there will be reasonable time periods for standard and expedited reviews, and appeals processes.
Other benefits of External IROs?
- Reviewers from all over the United States available
- Frees up medical directors and other administrators to concern themselves more with the tasks at hand that affect direct patient care and carry less administrative burden
- Pertains to medical necessity – of particular importance with the coming of ICD-10
- Providing clarification and necessary exceptions to cases that deviate from the norm – example? Cosmetic surgery would normally not be medically necessary, but in some cases, such as in reconstructive surgeries that restore function, they would be classified as necessary.
- Find yourself on the cusp of new technology, research and the very best medical care available.
- Know that you are compliant at state and federal leaves – put your mind at ease!