External Evidence-Based Reviews Keep Healthcare Sys...(more. Medical fraud reviews help insura...),Health

Medical fraud reviews help insurance payer special investigation units (SIUs) law enforcement agencies and service providers detect and prevent provider and claimant fraud, while saving the healthcare system money and time.

Disability reviews consider the reasonableness of a disability claim based on the medical evidence, the extent of the injury, whether the claimant can perform work and the appropriateness of rehabilitation treatment.

State level Independent medical reviews normally occur after all appeals mechanisms available within a health benefits plan are exhausted.

Rescission appeal reviews retroactively evaluate eligibility for health care coverage based on any misrepresentation of a pre-existing condition or medical history on an insurance application. IROs assure unbiased consideration for the review of the member's appeal.

Provider Reviews
Providers benefit from independent reviews because they are unbiased and provide an objective perspective of physician performance.

Hospital external peer reviews help hospitals and clinics evaluate ongoing physician performance, practitioner performance during sentinel events and practitioner credentialing and privileging to assure excellence in physician performance and deliver the highest quality of patient care.

Imaging reviews for hospitals and clinics completed by IROs help monitor the quality of hospital or clinic radiology services by reviewing images produced by computerized axial tomography (CAT or CT), positron emission tomography (PET) scans and X-rays. Imaging reviews determine whether the original physician's interpretation of the images was correct and the standard of care was met.

How IROs Help the Healthcare System
As an intermediary between health providers' plans and subscribers, IROs can balance fairly and objectively the needs of both at the same time assuring standards-based processes are followed.

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