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Citing Independent Medical Review Challenges, IRO Group Stresses Importance of Accreditation

Thursday, September 1st, 2016

In a recently released white paper, the National Association of Independent Review Organizations (NAIRO) outlines the efforts of its URAC-accredited and other member organizations to overcome the leading challenges impacting the field of independent review.

“Understanding the Vital Role of Independent Medical Review and Utilization Review Services” identifies these pressing issues and how IROs can “foster a greater understanding” of their “often-complex” process. Challenges include an underutilization of services as well as quality issues such as timeliness, documentation, reviewer qualifications, avoiding conflicts of interest, and the handling of experimental and investigational reviews.

Offering potential solutions, the report cites accreditation as the “gold standard” for IROs. NAIRO states that accreditation “is important for the overall integrity, consistency, and accuracy” of IROs.

Issues cited by NAIRO are addressed in the standards URAC developed for IRO accreditation. According to the white paper, accreditation shows that IROs “adhere to specific, rigorous standards” and are “fair and transparent.” It adds: “By using only accredited IROs, health plans and consumers gain assurance that appeals receive a comprehensive review and objective decision.”

URAC offers separate IRO accreditation programs for internal and external review. It also offers a comprehensive accreditation for organizations performing both types of review. Standards address URAC’s core health care quality issues along with specific issues that affect IROs such as conflict of interest, reviewer credentialing, and aspects of review processes.

For more information on the URAC accreditation program used by the majority of NAIRO members, go to urac.org/iro.

Interested in accreditation?
Contact businessdevelopment@urac.org

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