Why Outsource to an Independent Review Organization (IRO)?

Many payers and medical management companiespayer, outsourcing to an IRO is a great way to
have not discovered the power of outsourcingassure that you make fact-based medical claims
their medical decision making to an independentdecisions and pre-authorizations every time--even
review organization...often because they've alreadythe most expensive and complex claims and
assembled their own panel of internal doctors ortreatments. IROs have mechanisms in place to
using their own medical staff to make suchprovide decision making with a high degree of
decisions. Yet with rising state and federalefficiency and at a very low cost.
regulations regarding the need for objective,A good IRO has a full time recruiting and
unbiased decision based purely on medical fact,credentialing function that builds and maintains a
independent review organizations (IROs) offer aspecialist panel with all types of physicians and
simple, easy alternative to other forms of medicalsub-specialists, as well as allied health care
decision making, including pre-authorizations thatprofessionals. By using its panel, an IRO can easily
are critical for delivering high quality care accordingmatch each case with a like healthcare specialist
to patient needs.to make independent and objective medical
IROs play an important role in providing care indecisions. An Independent Review Organization
America's health care system today. Over theoften has a highly automated workflow for
last couple of decades, they evolved as a resultrouting cases to those physicians, getting their
of the patient rights movement. Patientsdeterminations in an efficient manner and typing
increasingly demanded a fair hearing and a fairand producing the written reviews that
decision about whether or not they would besubstantiate the decision in each case. IROs
approved medical treatments. IROs filled thatamortize their costs across hundreds (if not
need.thousands) of monthly cases. This advantageous
IROs began working by adjudicating and makingto a payer or medical management firm that
decisions on medical claims in the governmentdoesn't have similar case loads and therefore can
sector. Over the last several years, IROs havenot achieve the same economy of scale.
been utilized increasingly by mainstream healthIf your organization still has not unlocked the
plans and others making such determinations.power an Independent Review Organization for
IROs serve a vital role by advocating for themaking claims decisions and pre-authorizations,
patient while making sure that each patient onlyconsider outsourcing as a strategy for improving
receives the care they deserve based uponyour quality of care for your patient and
medical fact. Bottom line, IROs eliminate wastefulmembers. Independent Review Organizations
and unnecessary treatments.deliver exceptional value--with fast turn around
If you're a medical management company or atimes at low cost.