External Reviews have been conducted on the state level for some time; however, the new health care regulations per the Patient Protection and Affordable Care ACT (PPACA) also mandate a federal level appeal process. Help us out when submitting an external review by identifying whether your appeal is at the self-insured federal level or the fully-insured state level.

Going forward, all templates, notifications letters, denial letters that are state level appeals will be called “Fully-Insured” State-Level Appeals and will no longer be referred to as state IRO. The same rule applies to Federal level appeals, before called PPACA, will be referred to as “Self-Insured” Federal level Appeal.
The Advantages of Using Independent Review Organizations (IROs)The benefits and values of IROs go beyond ensuring accurate and proper medical services were provided.
By outsourcing to a physician review company, health groups, hospitals, medical agencies can reduce costs, recalculate resources with variable volumes, and allocate their medical directors to higher value-added tasks.

Security Enhancement
Clients are now protected with an additional layer of security. After five failed log-in attempts, submitters will be required to contact AMR’s customer support. This feature will prevent a breach of confidentiality in addition to unauthorized access.

Efficiency Improvement
Reviews are now easier to find! We have added additional filters to the search fields in order to enhance site navigation. If you are set up with multiple accounts, you can now search across all of them at the same time. Features also include significant updates to our internal system to further improve staff efficiency and better serve our clients.

Alerts
Our alert system automatically notifies clients of key changes with the review process. These are set up on a case by case basis. As an example, clients can opt to automatically receive a return e-mail with the AMR tracking number each time a review is created. Contact our dedicated Client Account Specialist (CAS) team at clients@admere.com to get your customized alerts turned on!

Reporting Features
Clients can generate customizable reports using any combination of fields. Once exported to excel, pivot tables are a useful tool to track trending over time. Our Client Account Specialist (CAS) team is also available to generate reports for clients.

The New Buzz in Social Media is Talking About Healthcare
Social media is no longer a new marketing phenomenon but a permanent fixture that is here to stay; it has the power to influence buyers in every business market. The public is now more inclined to weigh decisions on consumer reviews for health-related topics. Social media sites have become sources of information on treatment types or an outlet to assist in choosing particular physicians. Blogs and networking sites link people to healthcare companies more than the actual corporate marketing efforts. Social media as a resource is only becoming more credible in the health community. Forty-five percent of consumers said that on-line health forum posts would influence their decision to get a second opinion.

Now is the time for health organizations to capitalize on this opportunity as a way to receive personal customer input and provide an immediate response. Social media will allow healthcare companies to use the interactive nature as a tool to measure lifestyle and behavior patterns to help inform care plans. Health organizations can also use patient-reported data as a way to improve customer service, provide higher-quality care, and create more efficient products that will positively shape the healthcare market.