NAIRO Issues Guide Illuminating Independent Medical Review Services
Aug 10, 2022
ALBANY, N.Y. - August 10, 2022 - (Newswire.com)
At a time when the role of independent medical review has never been more vital within the healthcare system, the National Association of Independent Review Organizations (NAIRO) released a white paper outlining the pivotal work of accredited independent review organizations (IRO) in their ongoing effort to deliver fair and rigorous medical review services.
Comprised of the majority of URAC-accredited IROs, NAIRO promotes the quality and integrity of the often-complex independent medical review process. Independent medical review sits at critical junctures along several facets of the healthcare system - from external appeals involving payers and consumers to the more recent arbitration system that's come online as a result of the No Surprises Act of 2020 (NSA) and federal surprise billing regulations.
"Independent medical review is crucial to maintaining balance within healthcare, yet it is a process that often goes unseen," said Gib P. Smith, Executive Director with NAIRO. "We want to put a spotlight on the work that IROs do day in and day out as evidence-based arbiters of complex coverage and payment determinations."
The white paper, Understanding the Vital Role, Challenges, and Opportunities of Independent Medical Review Services, offers readers a brief history of independent medical review, a behind-the-scenes look at internal and external appeals, a series of challenges that NAIRO is striving to meet, reasons why accredited IROs are an industry gold standard, and a crash course on newer review services, such as the independent dispute resolution process that's part of the surprise billing regulations.
The scope and role of independent medical review has grown significantly in recent years, yet few consumers utilize the process. As the paper details, one study found that, on average, less than one out of every 10,000 eligible individuals requested an external review of their denied health claim.
"As we look to the future of independent medical review, we see a lot of growth and potential," Smith said. "Part of our work is to describe the value that accredited IROs bring to healthcare stakeholders, from consumers to health plans to providers."
To read the full report, visit NAIRO's industry-leading blog, www.nairo.org/updates, or review the attached PDF.
About NAIRO
NAIRO (The National Association of Independent Review Organizations) was formed by the majority of URAC-accredited IROs. The mission of NAIRO is to promote the quality and integrity of the independent review process at the internal and external levels. Utilizing the expertise of board-certified clinicians throughout the country, NAIRO members embrace an evidence-based approach to independent medical peer review, in order to help resolve coverage disputes between enrollees and their health plans. More information can be found at www.nairo.org.
Related Files
NAIRO_Understanding Independent Medical Review Services-2022.pdf
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Original Source: NAIRO Issues Guide Illuminating Independent Medical Review Services
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