Consistent external review processes will benefit consumers, regulators and
the healthcare industry
LANSDALE, Pa., June 10 /PRNewswire/ -- Lack of consistency related to the external appeal process is a big issue facing healthcare reform, says NAIRO (National Association of Independent Review Organizations), a trade organization for IROs. While 44 states and Washington, D.C. have external review laws, each is different. A nation-wide standard would provide consumers with greater consistency in the appeal process when an insurer denies coverage. Widely varying external review laws can significantly affect consumers, and unnecessarily increase healthcare complexity.
Standardization of independent medical peer review processes, timeframes, methods, and credentialing requirements throughout the United States is a important issue on the NAIRO agenda. It is why NAIRO supports the National Association of Insurance Commissioners (NAIC) "Uniform Health Carrier External Review Model Act," which moves external review toward a common process for all states and reduces healthcare confusion.
"NAIRO fully supports NAIC's approval of its External Review Model Act," said Joyce Muller, NAIRO president. "It's in the best interest of regulators, the healthcare industry and consumers to simplify the overly complex external review processes that most states use to protect consumers."
NAIRO is also a proponent of the requirement that nationally accredited independent review organizations perform the reviews. "We believe the healthcare consumer benefits if nationally accredited IRO's are selected for this process," said Muller. "Accredited IRO's undergo an exhaustive process that ensures consumers will receive the highest quality independent review of their denied claim." Today many policy makers recognize that private accreditation ensures their constituencies receive quality health care.
URAC (formerly the Utilization Review Accreditation Commission) is the largest accreditation organization in health care and accredits independent review organizations.
"Most states have established regulations that support patient's right by providing an appeal process for denied claims," said Muller. "NAIRO encourages all states to consider a more consistent national process for the benefit of all."
To read NAIRO's stances on healthcare issues, visit http://www.nairo.org/about.php.
|SOURCE National Association of Independent Review Organizations|
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