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

ment 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 litigati
'/>"/>

SOURCE NAIRO
Copyright©2009 PR Newswire.
All rights reserved

Page: 1 2 3

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:7/23/2014)... July 23, 2014 Low enrollment ... insurance exchanges to come up with alternative means ... the myriad ways to accomplish this in the ... Health Insurance Exchanges (HEX). , “We never expected ... state-run exchanges, Christopher Condeluci, an attorney at the ...
(Date:7/23/2014)... Hills, CA (PRWEB) July 23, 2014 ... 90 million Americans suffering from chronic bad breath that the ... whom they speak. , Dr. Saj Jivraj and Dr. Mamaly ... Woodland Hills, Calif., are concerned that some people may be ... breath often is a sign of an infection or chronic ...
(Date:7/23/2014)... 2014 On July 19 and 20, the ... NBC 4 New York and New York Giants Health & ... , The team, which included several hearing healthcare ... free hearing health screenings and answered any questions that attendees ... technology. , Also sponsored by the NFL Players Association, ...
(Date:7/23/2014)... TeraGanix has recently announced the opening ... only 4.5 miles off of highway I-8. The new production ... for businesses in the Arizona region that use its popular ... Casa Grande location is only 1 hour away from Tucson, ... Phoenix. With over 26 million acres of agricultural land ...
(Date:7/23/2014)... Seattle, Wa (PRWEB) July 23, 2014 ... body sweats, it means that it is healthy enough ... is also useful for “washing out” harmful toxins and ... excretory system of the body just cannot do. ... prone to hyperhidrosis—or more commonly known as “excessive sweating”—are ...
Breaking Medicine News(10 mins):Health News:Industry Observers Tell AIS They Predict Changes to Exchange User Fees, Platforms 2Health News:Industry Observers Tell AIS They Predict Changes to Exchange User Fees, Platforms 3Health News:Woodland Hills’ Top Cosmetic Dentists Offer 6 Tips on Causes of Bad Breath That Should Concern You 2Health News:Woodland Hills’ Top Cosmetic Dentists Offer 6 Tips on Causes of Bad Breath That Should Concern You 3Health News:Woodland Hills’ Top Cosmetic Dentists Offer 6 Tips on Causes of Bad Breath That Should Concern You 4Health News:Woodland Hills’ Top Cosmetic Dentists Offer 6 Tips on Causes of Bad Breath That Should Concern You 5Health News:The HearStrong Foundation Provides Hearing Healthcare Awareness at the NBC 4 New York and New York Giants Health & Fitness Expo 2014 2Health News:TeraGanix Opens New Arizona-Based Agricultural Products Supply Facility 2Health News:TeraGanix Opens New Arizona-Based Agricultural Products Supply Facility 3Health News:Beat Your Sweating Demons Review | The Problem With Excessive Sweating and Solving it Naturally – Vinamy.com 2Health News:Beat Your Sweating Demons Review | The Problem With Excessive Sweating and Solving it Naturally – Vinamy.com 3
... of white rice weekly can up risk of type 2 diabetes, ... brown rice or another whole grain for white rice can help ... , Five or more servings of white rice a week increased ... the study, which is published in the June 14 issue of ...
... Doctors have long known that snoring is hazardous to ... restless nights and increased daytime sleepiness, sleep-disordered breathing (SDB) ... risk of cardiovascular disease (CVD). While it is not ... given health problem is, new research exposes that at ...
... Men with this history are more prone to hit and ... -- Men who attempted suicide before age 18 are much ... a study from the Oregon Social Learning Center in Eugene. ... neighborhoods who were assessed annually from ages 10 to 32. ...
... ... Site to Advance the Discussion, Innovations of Health Information Technology , ... Carrollton, GA (PRWEB) ... health record (EHR), practice management and interoperability solution PrimeSuite®, is today launching BlogEHR, ...
... JOLLA, Calif., June 15, 2010 Without knowing exactly ... take non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin have lower ... study appearing in Cancer Cell on June ... their colleagues have figured out how one NSAID, called ...
... ... Achieves a Smoother, Firmer Skin Surface , ... Los Angeles, Calif. (PRWEB) June 14, 2010 -- For ... problem areas and achieve a slimmer, smoother and firmer appearance. However, the procedure is ...
Cached Medicine News:Health News:Brown Rice Bests White for Diabetes Prevention 2Health News:Brown Rice Bests White for Diabetes Prevention 3Health News:Possible link between sleep-disordered breathing and cardiovascular disease revealed 2Health News:Teen Boys Who Attempt Suicide More Likely to Abuse as Adults 2Health News:Industry Leaders Featured in Greenway's BlogEHR 2Health News:Industry Leaders Featured in Greenway's BlogEHR 3Health News:Turning a painkiller into a cancer killer 2Health News:Why More Women are Choosing OptiLipo over Liposuction 2
(Date:7/23/2014)... , July 23 2014 Ampio Pharmaceuticals, Inc. ... new headquarters, manufacturing and research facility: Ampio ... 80112 Direct: (720) 437-6500 Michael ... pharmaceutical drug manufacturing facility will be fully operational this ... first batches of Ampion TM necessary to accommodate ...
(Date:7/23/2014)... , July 23, 2014  ArmaGen, a ... therapies to treat severe neurological disorders, announced today ... and collaboration agreement with Shire plc to develop ... potential treatment of both the central nervous system ... Also known as MPS II, Hunter syndrome is ...
(Date:7/22/2014)... July 23, 2014   - Investment ... Pharmaceutical Co., Ltd. (hereinafter "Taiho"), a fully-fledged oncology pharmaceutical ... be investing US$30 million in Remiges BioPharma Fund (hereinafter ... Taiho has a long history of developing ... and cancer patients. Our development of TAS-102 is an ...
Breaking Medicine Technology:Ampio Pharmaceuticals announces the opening of its new headquarters, manufacturing and research facility in Englewood Colorado 2ArmaGen Announces Strategic Licensing and Collaboration Agreement with Shire to Develop AGT-182 for Treatment of Hunter Syndrome 2ArmaGen Announces Strategic Licensing and Collaboration Agreement with Shire to Develop AGT-182 for Treatment of Hunter Syndrome 3Taiho Pharmaceutical Invests US$30 Million in Remiges BioPharma Fund, LP 2
... September 9, 2011 The Board of the ... today it agreed to ratify the proposal of the US ... package, designed with the help of EFCG and US industry ... User Fees Act (GDUFA). GDUFA requires the FDA ...
... Advanced Wound Management division of Smith & Nephew (LSE: SN; ... studies on a range of products and therapies from their ... RENASYS* wound care portfolio. The data demonstrate advanced healing strategies ... products. Results of the studies are being presented at the ...
Cached Medicine Technology:European Fine Chemicals Group Ratifies FDA's Proposed Generic Drug User Fees Act (GDUFA) 2Smith & Nephew Showcases Strong Data at the Clinical Symposium on Advances in Skin & Wound Care Conference 2Smith & Nephew Showcases Strong Data at the Clinical Symposium on Advances in Skin & Wound Care Conference 3Smith & Nephew Showcases Strong Data at the Clinical Symposium on Advances in Skin & Wound Care Conference 4
... is a national reference laboratory and a ... development. ARUP offers an extensive test menu ... in clinical and anatomic pathology. Owned by ... include more than half of the nation's ...
... ARUP Laboratories is a national reference ... laboratory research and development. ARUP offers an ... unique medical tests in clinical and anatomic ... ARUP Laboratories' clients include more than half ...
... ARUP Laboratories is a national reference laboratory ... research and development. ARUP offers an extensive ... medical tests in clinical and anatomic pathology. ... Laboratories' clients include more than half of ...
... Laboratories is a national reference laboratory and ... and development. ARUP offers an extensive test ... tests in clinical and anatomic pathology. Owned ... clients include more than half of the ...
Medicine Products: