News

Safeguards protect against conflict of interest in the external review sphere

June 9, 2017
Conflict of interest is of paramount importance for the medical review process within health care

At a fundamental level, an IRO operates in an environment in which, by definition and with safeguards in place, the organization, staff and reviewers are free of any financial, organizational or other conflicts that may jeopardize the conflict-free nature of its review process.

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Reviewer anonymity remains threatened as IROs grapple with personal disclosures

May 26, 2017
NAIRO believes that reviewer anonymity is essential to the integrity of the review process

While most states do not require reviewer disclosure at the external-review level, anecdotal reports show that consumers often obtain personal details about an independent medical reviewer from their treating health care professionals, who may offer details unwittingly or may simply try to redirect a consumer’s complaints elsewhere.

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NAIRO Welcomes New Executive Committee Leadership Group

May 17, 2017
The leader in independent medical review appoints three leading experts to key posts
 
The National Association of Independent Review Organizations (NAIRO), which stands at the forefront of independent medical review and utilization review in health care, announced changes to its Executive Committee with the appointment of three long-standing experts in the field.

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NAIRO Releases Solutions to Prevailing Barriers Facing Health Care’s Independent Medical Review Process

July 29, 2016
New white paper enumerates key challenges – and solutions – to a core function of health care
 
July 29, 2016 – Today the National Association of Independent Review Organizations (NAIRO) released a set of guidelines outlining the path forward for an optimally functioning independent medical review process, a key component of evidence-based health care provision.
 
The white paper, ...

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Calif. Supreme Court rebuts court ruling that found UR physician liable for patients' health outcomes

April 22, 2016
Medical reviewers and workers’ compensation providers can breathe a sigh of relief – at least for now.
Last week the California Supreme Court ruled to officially depublicize a lower court’s previous ruling on the utilization review (UR) and workers’ compensation industries that would have set a precedent by holding UR physicians responsible for the care of patients whose cases the physicians review.
The ...

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Top 10 challenges for meeting HIPAA security compliance

February 1, 2016
Securing patients’ protected health information (PHI) is of paramount importance to limiting your financial risk based on the safeguards, and penalties, contained within the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and related amendments.
Yet many health care organizations are at significant risk of PHI-related security breaches. An overwhelming majority – 94% – of health ...

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NAIRO Position Paper

October 14, 2015
Accredited, Compliant IROs Lead the Way to Fair and Transparent Medical Review
Introduction
The National Association of Independent Review Organizations (NAIRO) seeks to clarify the guiding principles of independent review organizations (IROs), eliminate common misperceptions, and highlight the important role that accredited and compliant IROs play in determining a fair process – for all parties, including ...

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NAIRO Expands Education, Engagement With 2015 Cross-Channel Communication Plan

March 17, 2015
Education and support efforts are top priority for independent medical review leader
Further establishing its position as a leader in the field of independent medical and utilization review education, the National Association of Independent Review Organizations (NAIRO) announces a multipronged plan to enhance the education and support of its partners within the health care industry through social media platforms, ...

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Restrictive State Laws Can Compromise the Integrity of Independent Review

December 5, 2014
Accredited IROs call for states to revisit their laws that lessen the quality of independent review
Within the health care ecosystem, independent peer review plays a critical role in achieving transparent, evidence-based medical claims reviews. When functioning optimally, independent review delivers expertise to both health plans and consumers during the claims appeals process.
However, legislative action in ...

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Issue Brief: Independent Review Expands Its Scope: Case Studies in Context

October 15, 2014
Led by accrediting bodies, leading IROs deliver a greater breadth of services
 
Independent review is a critical component for ensuring the use of appropriate evidence-based health care along the continuum. Health plans, consumers and other invested parties benefit from the expertise of accredited independent review organizations (IROs) at multiple touch points within the health care system.
 
As a ...

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Providing Leading Assessments of Experimental and Investigational (E/I) Treatments

October 10, 2014
Independent Review Organizations deliver evidence-based reviews of E/I appeals
In the field of medicine, innovations occur every day, and every year brings a parade of new treatments, services and medications. Like other industries, some of these innovations become ingrained in daily use, others fade from relevance, and still others remain at the cutting-edge but are not yet part of standard practice. This creates ...

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Essential Health Benefits and Coverage Determinations Understanding the Rules and Regulations About Statutory Coverage Benefits

May 28, 2014
Prepared by Richard Scott
The 2010 Patient Protection and Affordable Care Act (PPACA) continues to have direct ramifications on health insurance providers, consumers and other stakeholders, as stipulations within the law shift from future outlook to present tense. One important trend, now officially part of healthcare coverage, is the topic of Essential Health Benefits (EHBs).
Under the law, the coverage of designated ...

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Issue Brief – External Review Options Available Under the Federal Facilitated and State Marketplaces

February 26, 2014
The Patient Protection and Affordable Care Act (PPACA) was enacted in March 2010. This landmark health legislation is altering the way health insurance providers are able to offer health insurance, and likewise transforming the way in which consumers are able to purchase insurance. Primarily, these changes are being driven by the creation and launch of the Health Insurance Marketplace (also known as the Health Insurance ...

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A Consumer’s Guide to Navigating the External Review Options Under the New Health Insurance Marketplace

February 26, 2014
This Issue Brief provides consumers with important information about external appeals as they relate to health insurance plans available within the new Federal and State Health Insurance Marketplaces.
To that end, this Issue Brief will provide consumers with:
Information on the typical use and function of external appeals.
A background on external appeals and the role of Independent Review Organizations (IROs).
The ...

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