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IROs Help Cut Health Payers' Costs and Improve Image
Date:2/26/2009

LANSDALE, Pa., Feb. 26 /PRNewswire/ -- In this recession, healthcare payers are challenged to do more with less, while delivering the same value to their members. For help reviewing complex or controversial appeal denials, they can find an independent review organization (IRO) through NAIRO (www.nairo.org), a national trade organization of IROs.

NAIRO members embrace an independent, evidence-based approach to medical review for resolving coverage disputes between enrollees and their health plans. The organization works to promote the value and integrity of the independent medical review process.

"Many states and the federal government require a timely independent review of denied appeals," said Joyce Muller, president of NAIRO (www.nairo.org). "During a recession payers are forced to cut costs, and outsourcing their medical claims and appeals decisions to IROs is even more compelling."

Specialty-matched reviews at lower costs

The number of medical specialties is growing and it would cost a payer millions of dollars to build and maintain an in-house panel of medical specialists that could provide the same clinical expertise found in an IRO. IROs recruit, train, credential and manage hundreds of specialists and subspecialists who are up-to-date on current treatments, procedures and technologies in their fields. Because they provide the clinical depth a payer cannot afford to maintain on staff, IROs can meet most regulatory, payer and member needs by providing unbiased, evidence-based decisions at lower costs. This reduces payer administrative costs, the number of subscriber appeals and potential litigation.

According to Muller, accredited IROs, like the 16 members of NAIRO, provide matched specialist clinicians with credentials similar to the provider recommending a treat
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SOURCE NAIRO
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