Many payer organizations have resorted to using retired physicians to review some of their medical claims, thinking that they are providing an effective claims decision making process. Yet, independent review organizations today provide a much better alternative. Why? Because independent review organizations, particularly those accredited by URAC, employ only board certified, licensed active practice physicians to review your medical claims. Why is this important? Standards of care continue to evolve at a very fast pace, and new medical technologies are being used all the time. A retired physician can not keep up with those emerging and changing standards and as a result, may not even be qualified to make an effective medical determination in most areas. On the contrary, an independent review organization has the capacity to maintain state-of-the-art specialist knowledge in all fields of care. IRO specialist doctors keep up with changing medical practices and assure that youre always getting objective determinations based in the most current medical facts. Board certified, licensed and actively practicing physicians are imperative for making valid medical decisions. If you're a payer or a health plan, or a medical management firm and you're not using these types of physicians with those types of credentials, you should reconsider your strategy and outsource your medical decision making to an IRO. An IRO will maintain that specialty panel of capabilities that will effectively provide you with up to date knowledge and expertise that's necessary to make the most complex medical decisions involving the most advanced treatments using the latest types of technologies. |
