Editor’s Note: Return on investment marks the real metric for changes in healthcare. This article defines a handful of metrics, including a Checklist for Outsourcing Reviews, for evaluating current review processes and resources. Click HERE and discuss how BHM compares to your organization’s existing processes.

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 checklist for outsourcing reviews.

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.

Checklist for Outsourcing Reviews

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.

Return on investment marks the real metric for changes in healthcare. This article defines a handful of metrics, including a Checklist for Outsourcing Reviews, for evaluating current review processes and resources. Click HERE and discuss how BHM compares to your organization’s existing processes.