ALBANY, NY – June 17, 2019 – URAC and the National Association of Independent Review Organizations (NAIRO) support Congressional legislation to protect patients from “surprise billing.” This practice has placed financial hardship on patients due to the lack of coordination in our delivery system and the misaligned billing practices of healthcare organizations. If Congress considers adoption of an arbitration model whereby an independent arbiter decides any payment disputes between health plans and providers, we believe that the arbiter(s) should be accredited independent review organizations (IROs). Payers, providers, and their regulators deserve an independent, qualified assessment regarding a payment determination. Accredited IROs have a 20-year history of protecting patients by serving as trusted independent clinical experts. Accredited IROs have a strong foundation avoiding conflicts of interest, utilizing high-qualified and specialized clinical reviewers and staff, and rendering accurate and timely decisions in a transparent manner. New York, New Jersey, and Illinois have all found success utilizing the arbitration model.
Founded in 1990, URAC is the independent leader in advancing healthcare quality through leadership, accreditation, measurement and innovation. URAC offers a wide range of quality benchmarking programs that reflect the latest changes in healthcare and provide a symbol of excellence for organizations to showcase their validated commitment to quality and accountability. URAC’s evidence-based measures and standards are developed through inclusive engagement with a broad range of stakeholders committed to improving the quality of healthcare. For more information, visit urac.org.
NAIRO (The National Association of Independent Review Organizations) was formed by the majority of URAC-accredited IROs. The mission of NAIRO is to promote the quality and integrity of the independent review process at the internal and external levels. Utilizing the expertise of board-certified clinicians throughout the country, NAIRO members embrace an evidence-based approach to independent medical peer review, in order to help resolve coverage disputes between enrollees and their health plans. More information can be found at www.nairo.org.