Navigation Links
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 treatment under appeal.

Because payers cannot employ every "same-kind" specialist needed to review subscribers' appeals as federal and state laws require, they can incorrectly approve or deny the appeal based on inadequate knowledge. This undercuts their profitability and consistency of coverage determinations.

Improving coverage policy accuracy

Although ERISA, Department of Labor and most state regulations call for independent review of appeals, many payers are handling appeals internally to save costs. But, this practice may increase their costs and raise the potential for litigation based on member-perceived conflict of interest. Evidence-based evaluations by IROs support these laws and can reduce the chance of paying questionable or unnecessary claims, while providing a more defensible, evidence-based determination that decreases re-examining cases that have been appealed.

Using an IRO, payers can avoid setting unwanted precedents for controversial coverage of complex and critical claims. An IRO review using up-to-date coverage policies allows payers to quickly and accurately approve or deny medical treatments. By supporting their coverage policies with current medical evidence and standards of care, they reduce unnecessary appeals and lawsuits.

Increasing subscriber good will

During a recession, payers should carefully consider the hidden costs incurred by reviewing appeals internally with the cost of using an IRO. Independent medical reviews by IROs ensure subscribers receive their coverage benefits without administrative delay, while providing objective support for payers.

"Research by some of our members shows a return on investment of $15 to $20 for each dollar spent on appeals reviewed by the IRO," Muller said. "Unbiased medical reviews also improve good will between payers and subscribers, increase enrollments and reduce litigation opportunities."


'/>"/>
SOURCE NAIRO
Copyright©2009 PR Newswire.
All rights reserved

Related medicine news :

1. Independent Review Organizations Take Pressure Off Healthcare Payers as Recession Deepens
2. Virtua Health Takes Next Step for Continuing Hospital Construction
3. VVA Introduces Collaboration Between Veterans and Private Sector to Address Healthcare Needs for Vets
4. Taming Wide Variations in Spending Key to Health Reform - New England Journal of Medicine Commentary from Dartmouth Atlas Project
5. Nurses Welcome Presidents Call for Comprehensive Health Reform
6. Governor Rendell Forms Food Safety Council to Protect Public Health, Food Supply
7. L.A. Area SEIU Members Gear Up to Support Effort to Fix Healthcare; Plan Rally for Thursday
8. Mercy Health System Provides Free Prostate Seminar
9. CBOs Take on Prevention Programs Misses the Point of Health Reform
10. United Spinal Association Introduces The Veterans Health Council: Improving Veterans Health through Information and Advocacy
11. The Merck Company Foundation Launches Five-Year Effort to Close Healthcare Disparity Gaps
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:12/8/2016)... ... , ... David J. Dykeman , Ginger Pigott , and ... at DeviceTalks West, Dec. 12, 2016, at the Fairmont Newport Beach in California. Greenberg ... global Life Sciences & Medical Technology Group have been featured speakers at every DeviceTalks ...
(Date:12/8/2016)... ... December 08, 2016 , ... SunView Software aims to redefine ... are both engaging and easy to use. Coming off the heels of a ... today its plans to roll out new AI-powered self-service enhancements to help organizations ...
(Date:12/8/2016)... ... December 08, 2016 , ... ... solutions for drugs, biologics and consumer health products, today announced that it had ... in 2006 as a non-profit organization to unite pharmaceutical and healthcare companies that ...
(Date:12/8/2016)... ... ... STAT courier is pleased to announce that due to customer demand, as well ... presence in Dallas. One of the most exciting parts for STAT is that the ... and Forth Worth market. STAT takes pride in treating their employees with integrity and ...
(Date:12/8/2016)... ... December 08, 2016 , ... ... surgery as possible. With this in mind, SIGVARIS has created a new line ... clot) during bed rest and provide the benefits of graduated compression when transitioning ...
Breaking Medicine News(10 mins):
(Date:12/8/2016)... FLINT, Mich. , Dec. 8, 2016  Diplomat Pharmacy, Inc. ... as a 2016 Top Workplaces National Standard. ... . ... Diplomat Specialty Pharmacy (PRNewsFoto/Diplomat Pharmacy, Inc.) ... are based on an employee survey administered by WorkplaceDynamics, LLC, a ...
(Date:12/8/2016)... Research and Markets has announced the addition of the "Endodontic Supplies ... ... the worldwide markets for Endodontic Supplies in US$ Thousand. The report provides separate ... , Europe , Asia-Pacific , ... and forecasts are provided for the period 2015 through 2022. Also, a six-year ...
(Date:12/8/2016)... CAMBRIDGE, Mass. , Dec. 8, 2016 /PRNewswire/ ... today that Nationwide Children,s Hospital signed ... enhance and accelerate the development of new cures. ... healthcare organizations representing over 57 million patients globally, ... are working together to improve protocol design, site ...
Breaking Medicine Technology: