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Fair IDR: The Way Forward To Protect Patients & Resolve Surprise Medical Bill Disputes

       

 

Fair IDR: The Way Forward To Protect Patients & Resolve Surprise Medical Bill Disputes

Protecting patients from surprise medical bills is a national concern.1 The stories of financial hardship placed on patients from surprise medical bills, whether due to lack of coordination in our health care delivery system or misaligned billing practices of health care organizations, are well told. In fact, over 57% of American adults have received at least one surprise medical bill.2

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Caution: Push for Expedited Medical Review Services Can Compromise Review Quality

Independent medical peer review services are a fundamental part of the U.S. health care system, providing valuable, evidence-based decisions on medical claims.

However, there is an emerging trend that is pushing for faster medical review determinations, particularly in the event of non-acute and non-emergent situations. This trend can potentially compromise the quality of independent review services for the intended beneficiary – the enrollees.

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Solutions for Surprise Billing: Accredited IROs Offer Unparalleled Benefits

The act of surprise billing – when a patient receives an unexpected medical bill, sometimes for thousands of dollars or more – is a common occurrence within the American health care system. Studies show that roughly 20% of surgical patients receive a surprise bill, at an average of $2,000 in non-covered fees.

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Work from Home (WFH) Emerges as One Aspect of the New Business Continuity Model for Independent Review Entities

Though states are responding differently to the COVID-19 public health emergency (PHE), current stay at home orders in many regions and the hesitation for companies and employees to return to the office have brought attention to a previously under-the-radar element of business continuity. Namely, the potential for operational disruptions brought on by situations where your workforce cannot attend the office, or where your office is forced to close.

Accreditation and certification organizations have varying requirements to respond to the disruption of normal business, whether it is called business continuity, as in the case of URAC, PCI, or HITRUST; Disaster Management (NCQA); or Business Continuity Management (ISO). Emergency situations that can trigger a WFH business continuity model might be anything from the current PHE to prolonged power outages, severe weather, earthquake damage or other disruptive situations.

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Guide to the New Members-Only Area

We are very excited to present the all-new NAIRO website and association management platform! This website will help with the work of keeping our membership connected. With social networking support, simple tools for staying in touch, space for sharing documents and photos and resources to support committees, we can use it to help market our association and highlight great work being done.

In addition, NAIRO.org is going to be the workhorse that will collect member dues and support event registration and payment.

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HOW CLINICIAN CREDENTIALING BEST PRACTICES HELP LEADING ACCREDITED IROS ENSURE INDEPENDENT MEDICAL REVIEW

April 15, 2019 – One of the pillars of protecting the integrity of the review process for all stakeholders within the healthcare industry is to conduct secure and prudent clinician credentialing. This is a critical process within the realm of independent review organizations (IRO) and utilization management (UM) organizations.

Vetting and contracting with qualified clinicians is key because health plans and patients rely on the expertise of those clinicians to render accurate reviews. Today, leading IROs and UM organizations are advancing the credentialing process, which largely plays out behind the scenes but is vital to preserving the independence and integrity of medical review.

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