In the constantly evolving world of medical research and development, cutting-edge treatments start out in a clinical trial setting and, if proven safe and effective, will become acceptable in the day-to-day practice settings of health care providers. Some advanced cancer treatments and biological therapies are just two examples of treatment methods that will pass through…
Many times in the demanding field of external medical review, the art and science of producing a high-quality report comes with its own set of unique challenges and obstructions. Independent review organizations (IROs), which provide non-biased reviews of medical coverage and other decisions, often face rapid deadlines, incomplete medical records and what can be a…
Recent court cases have cast a shadow of risk among independent review organizations (IROs) and those providing utilization review services.
By law, consumers have the right to pursue an external review performed by an independent body or independent review organization (IRO), which may impact or possibly reverse the original denial.
Conflict of interest is serious business in any industry, and it is of paramount importance for the medical review process within health care – where people’s health and well-being are at stake.
NAIRO believes that reviewer anonymity is essential to the integrity of the review process, but sometimes reviewers are disclosed inadvertently.
Calif. Supreme Court rebuts court ruling that found UR physician liable for patients’ health outcomes
The California Supreme Court depublicized a lower court’s ruling on utilization review regarding a reviewer’s duty of care.
While organizations believe in securing patients’ protected health information (PHI), 94% admit to at least one PHI breach within the past two years.