Make Your Next Review Easier (and possibly save money)
If you´re a claims manager, case manager or utilization management nurse and are sending cases to an IRO for independent review, here are four important tips that can make your next review easier—and maybe less costly.
1. State your question clearly. Explain just the issues that you want the IRO to review about your case. Point out any defining issues that are important to consider.
2. Ask questions that get to the heart of the issue. Framing your questions properly is important when you´re asking for an independent medical review. Asking vague, redundant or extraneous questions about the case can confuse the reviewer and miss the heart of the matter. As a result, it will probably cost you more for the review.
3. Don´t overstate the number of questions you want answered. The cost of an independent medical review is directly related to the number of questions that you want reviewed. The number of pages reviewed also determines the cost. When an IRO looks at a thousand pages on a case, it´s going to cost far more than reviewing a hundred pages.
4. Send only documentation that is relevant to the case you want reviewed. You can reduce the cost of your medical reviews by making sure that you only send your IRO the pages that apply to the case. It´s not that IROs want their clients to remove pages that could provide good background information about the case, but it does make sense for you to remove any spurious internal communication not relevant to the case being reviewed.
When you are considering submitting cases to an IRO for medical review, make sure you frame your questions properly, succinctly state them and ask only those that are important for the IRO to deliver a determination. This will help increase turnaround times and may even cost your organization less.