Independent Medical Reviews

Outsourcing Medical Reviews: Productivity Through Partnership

October 12, 2018

Physician with stethoscope around his neck conducting peer reviews on his laptop as part of medical outsourcing services.

The ability to multitask is often seen as positive because it enables a person to perform more than one task at a time. However, research has shown that it not only decreases productivity and raises risk but also creates distraction and reduces memory.

Based on this research, asking employees to multitask on a regular basis may not reap the benefits employers desire. This is especially true in the medical field, where errors can have a bigger impact on an individual. One such area is independent medical peer review, conducted as part of medical coverage appeals, in which medical records undergo evidence-based clinical review to ensure patients are given appropriate and necessary treatment that adheres to specific guidelines and/or state and federal requirements.

Outsourcing these reviews to a certified independent review organization (IRO) offers a host of benefits, like freeing up in-house medical directors to focus on other areas and lessen the burden of multitasking. It also provides a cost and time-effective resource to handle reviews when an organization has an overflow of cases. Other benefits achieved by utilizing the services of an outsourced review organization include 24/7 support for quick turnaround, enhanced compliance and independent unbiased medical expertise.

Steady Support

By offering dedicated services through a stable workforce and diverse medical panel, IROs are able to provide support to clients 24/7. They can meet brief deadlines and communicate with clients in a very timely manner, resulting in faster turnaround for reviews. Plus, due to the higher volume of reviews they handle, costs can be contained, meaning less expense for their clients.

Streamlined Compliance

Medical reviews adhere to clinical guidelines set forth according to specific plan, state, and federal requirements. URAC-accredited IROs are consistently up-to-date on these guidelines and accurately apply that knowledge to every case. By investing in the services of an IRO, organizations can ensure compliance with applicable state and federal requirements for appeals and medical necessity determinations, in addition to DOL/ERISA, ACA, State Department of Insurance and Workers’ Compensation mandates.

Independent Knowledge

IROs contract with board-certified physician reviewers who are clinically knowledgeable across a wide range of specialties and subspecialties. Acting as an independent, unbiased resource, they boost client satisfaction by ensuring reviews are completed in a timely manner, referencing guidelines and facilitating peer-to-peer calls, when appropriate, in the process. IROs also maintain a nationwide network of board-certified physicians, most of whom are in active-practice, who understand and have experience with payers, providers and patients to deal with each and every case they encounter.

Proven Partners

Making sure you select the right partner for outsourced medical reviews is essential. Choose one that has proven success, employs a highly-trained compliance staff and is HITRUST CSF-certified and fully accredited by URAC, which is the entity that certifies IROs. Also, it’s important to partner with an IRO whose physician network is robust enough to cover all specialties and subspecialties throughout the country.

IROs utilizing flexible and customizable technology in medical reviews are able to provide additional benefits to their clients. For example, the Advanced Medical Reviews client portal offers an intuitive, secure and customizable platform to assist client operations through fast processing, and specialized reporting while streamlining the submission, tracking and reporting of reviews.

Another feature extended by AMR is its nationwide reviewer network, which is particularly advantageous for clients who need or desire state and specialty matches for their reviews. The network provides a comprehensive tool to complete the necessary steps, with the appropriate clinical expertise, in a timely manner.

To learn more about the benefits an outsourced medical review organization offers, please subscribe to the AMR Blog.

Outsourcing Medical Reviews: Productivity Through Partnership