With healthcare reform well under way, External Independent Review Organizations, (IROs) have become a requirement nationwide. For some, it’s a welcomed change to current strategies, but for other organizations, there might be a lot of unanswered questions about that transition, the motivation behind it and the necessity.
Maybe you've heard us talk about IROs before, but you're still not 100% certain why you really need one. Independent Review Organizations have many features and benefits that extend beyond the realm of medical neccesity. In today's post, we'll make the case for IROs so the full picture becomes more clear.
Many case managers look to Independent Review Organizations (IROs) to get help with decision-making and for outside perspective from a trusted source. For some, their collaboration is required. So how do you know when it's time to start working with an IRO? Here are 10 instances which can help you better identify when its time to look for a partner.
When we talk about outsourcing, the first defense that’s likely to surface is, “won’t that cost more money?” Hospitals frequently make the mistake of assuming that by conducting claim reviews in house they are automatically saving money. This illusion is understandable, since it’s long been the belief in many industries that the more you can do for yourself, the less money you have to spend hiring someone else to do it.
Managed care has been around for almost one hundred years, at least in theory. When placed up against fee-for-service payment models, however, it was a hard sell. Traditionally, the way that physicians were compensated for their services was a fairly straight-forward invoicing process: they would bill the patient (or later, the payer) for everything they did in terms of diagnosing or treating the patient. Everything.
Peer review and quality. Healthcare is an industry that perhaps has even surpassed car manufacturing in concern with quality measures. And it should be. After all, we’re dealing with human beings, not cars. Peer review often concerns itself with peering closely at quality measures, compliance and safety. Patients are already vulnerable when they enter the hospital, due to illness or injury, so it is everyone’s concern in healthcare to be mindful of what areas of weakness within an organization could be influencing patient outcomes in a negative way.
IRO | Decision Making In any industry and, in some regards, in any life - there are times when an outside perspective is the difference between progress and an impasse. In the world of healthcare, where often the bottom line of organizations can be at odds with the wants and needs of the patients and payers, a third-party perspective can help to untangle the web of miscommunication.
There are few things more frustrating to a physician than a pile of Medical Necessity edits. Medical Necessity is the term we use in healthcare to describe care what is reasonable and appropriate for a patient based on evidence-based care standards. This has become something of a major bone of contention between payers and physicians, because, often times, physicians don’t understand why their clinical judgment is being brought into question.
With healthcare reform well under way, External Independent Review Organizations, (IROs) have become a requirement nationwide. For some, it’s a welcomed change to current strategies, but for other organizations, there might be a lot of unanswered questions about that transition, the motivation behind it and the necessity.
As part of BHM’s new partnership with The Doctor’s Channel, Mike Forrester, BHM’s Senior Vice President Independent Review Organization (IRO) Division, speaks about the amazing technology advancements that enable instant communication between clients, physician reviewers and BHM Healthcare Solutions.