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Independent Review Organizations Poised to Help Reduce Rising Healthcare Cost

LANSDALE, Pa., Feb. 4 /PRNewswire/ -- According to the National Coalition on Health Care, the increasing cost of health care outstrips both wages and inflation. Each year premiums rise at almost double-digit rates. If this continues, healthcare costs will rise from five percent of the GNP to 13 percent by 2050.

Within the healthcare industry, independent review organizations (IROs) offer hope for reducing healthcare costs. IROs act as third-party medical review resources providing unbiased medical opinions to support effective decision making for health plans and other payers. Basing decisions on medical evidence and the detailed facts in each case, IROs deliver conflict-free decisions that help clinical and claims managers allocate healthcare resources better and reduce waste.

"We believe IROs play a key role in reducing healthcare costs," said Joyce Muller, NAIRO president. "While they are little known, IROs exist to assure that people paying for health care get what they've paid for and health insurers only pay for medically necessary treatments."

This election year candidates from both parties are proposing solutions to the healthcare problem. "Greater attention is focused on keeping the escalating costs of healthcare down, and the effective use of IRO's contribute to that," Muller said.

IROs can help health plan providers and payers reduce costs by assisting with decisions like these:

-- Ensure compliance with state mandates for appeals and medical necessity


-- Help payers meet Dept. of Labor (DOL) and Employee Retirement Income

Security Act of 1974 (ERISA) compliance guidelines

-- Determine when a treatment is needed medically

-- Decide whether a treatment is experimental based on the latest medical


-- Decide if health plan language is outdated or ambiguous

-- Investigate fraudulent claims

-- Explore patient safety and quality-of-care issues

-- Reduce liability by using external, board-certified doctors in the same

field as original providers

-- Help payers standardize medical criteria for pre-authorization

-- Improve member satisfaction by providing unbiased, external opinions

-- Eliminate conflict-of-interest concerns


Formed in 2000, NAIRO works to promote the value and integrity of the independent medical review process, as a key part of the solution to America's healthcare crisis. Its members embrace an evidence-based approach to independent medical review to resolve coverage disputes between enrollees and their health plans. For more information visit

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