5 Signs That It Is Time to Reevaluate Your Independent Review Organization

August 14, 2015
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BHM Healthcare Solutions | Independent Review OrganizationHave you gotten comfortable with your independent review organization?

The real question is, have you gotten a little too comfortable wit

BHM Healthcare Solutions | Independent Review OrganizationHave you gotten comfortable with your independent review organization?

The real question is, have you gotten a little too comfortable with your Independent Review Organization to the point where you have not seriously examined your contract or services in a while?

It is great to keep moving along with a vendor that you have a well-established relationship with, however, as in all aspects of business, the time comes when you should probably re-examine the relationship and make sure that you are getting the same level of quality and value out of it that you once were. Significant changes have occurred in the healthcare market in the past two years alone, but most organizations only re-examine vendor agreements every three to five years.  This could lead to loss of cost savings, lower quality of services, and prolonged agreements with organizations who have not kept up with the quality, security, and technology needs of today’s market.Here is our list of 5 Signs that it may be time to reexamine your Independent Review Organization, and how it can greatly benefit your company to do so.

  1. It has been more than a year since you have looked at your contract and your vendor

Time flies, but in healthcare things have been moving and changing at an incredible pace, if it has been over a year since you began contracting services from an Independent Review Organization now is a great time to re-evaluate the service offerings.  In fact, most often organizations do not re-evaluate their vendors for periods of 5 years or more. This can be problematic as Accreditation cycles typically occur every three years, and the level of change in terms of HIPAA and the Affordable Care Act have been phenomenal in a short period of time. This could be half a decade of non-competitive pricing, low quality of services, and internal inefficiencies that you are subjecting your organization to.

Dust off that contract, and speak to staff to determine if services are being delivered as promised.  Here are just a few questions you may want to consider:

  • Have our needs/volume changed since contracting?
  • Has our vendor met new expectations?
  • What is our current level of satisfaction with the services provided?
  • Are there any ways in which you are dissatisfied with the services?
  • Do you need increased reporting and the organization has been unable to provide it?

The healthiest contractual relationships are those which continue to provide value and stay adaptive to industry changes.  Make sure that your contracted vendors are keeping up with your needs.

  1. You don’t know the Accreditation Status of Your Vendor

Having a URAC Accredited Independent Review Organization is critical and helps ensure that you are getting the highest quality reviews by an Independent Review Organization.  Some, but not all organizations mandate that an Independent Review Organization is accredited for contracting purposes, but few check in on the accreditation status of their vendors.

What URAC Independent Review Organization Accreditation Means for You

  • Highest quality of reviews
  • Appropriately trained and credentialed reviewers
  • Elimination of conflicts of interest
  • Specific mandated timelines related to reviews
  • Process on continuous quality improvement related to reviews
  • Security and Data integrity of reviews and patient data
  • Strict adherence to Medical Necessity Guidelines

You should ask the following key questions

  • Is my IRO vendor URAC Accredited? (find out by clicking here)
  • Has there been any change in accreditation status since initial contracting?

Many organizations have recently become accredited, which is great news for you.  Others may have opted to let their accreditation slide, or may have failed re-accreditation.  It is important that you are aware of these instances and should always make sure you know a vendors accreditation status.

  • When is my vendor undergoing re-accreditation?

As stated, organizations typically go through a re-accreditation process every three years, and as unfortunate as it is, some organizations do not pass.  You should always know the accreditation status of any contracted Independent Review Organizations, especially if accreditation is required of this vendor for your organization and/or if you only have one vendor.

What would you do if your Independent Review Organization did not achieve successful re-accreditation? Make sure that you are not caught unaware and always have a contingency plan.

  1. Your Current Independent Review Organization has not made any technological advancements

Is your Independent Review Organization still utilizing faxes and emails…..and its terrible to say…old fashioned snail mail for the completion of reviews and/or common communication?

Technology has been changing as an incredible rate, and your Independent Review Organization should be keeping up with this.  Ask the following questions related to technology to ensure that you are not using a company who is utilizing communication methods from a decade ago.  There are a few reasons why this is critically important:

  • Outdated technology causes a critical security risk to the private patient information of your consumers….you may be HIPAA compliant, but your IRO may not be!
  • Lack of updated technology creates massive utilization of resources and duplication of work – this costs you time and money
  • How can you run a report off of a fax? If your independent review organization is not utilizing the latest technology the data that you have to make decisions is most likely woefully inadequate…this can drastically impact your bottom line and prevent you from identifying key trends
  • Poor quality error prone reviews often occur when there are no automated features in the provision of reviews, technology reduces human error, improves review timeliness and quality and ensures that your patients and consumers get the type of quality of care and service that the new healthcare environment demands
  1. You are not sure what the standard rate for review types is, and you are paying the same rates you have always paid

Markets shift, services and requirements change, volumes of reviews to an Independent Review Organization can increase and decrease, but if you have not examined the pricing agreement of your Independent Review Organization lately we invite you to take a renewed look.

Even if you are completely satisfied with your current vendor, you should get an idea of what competitors are pricing for the same services.  With movements in the IRO industry we have seen a bi-lineation among Independent Review Organizations and there is definitely room for cost savings if it has been a while since you have examined pricing.

Those who have kept up with technology and continue to drive efficiency have seen a stabilization or lowering of rates with improved quality of reviews.  Those who have not made the investment are often times more highly priced in the market with no offset quality benefit.

Quality is critical, and that can cause a differentiation in rate, but be sure that your vendor offers the same or higher level of quality and satisfaction in a measurable way at a competitive industry price point, and don’t make the false assumption that prices have risen over the past few years….in many cases those grandfathered rates are actually higher than current competitive market rates for the provision of reviews.

  1. Are you getting service that works for and with the way your organization operates

Is your Independent Review Organization relationship all about the review company and less about your organization’s needs?  Do you get the level of customer support that you require?  How does your Independent Review Organization step up to the plate when it comes to special requests?  These are all critical questions that you should ask, and here are some additional points to consider

  • Many organizations are increasingly required to have complex reporting needs met. These can be utilization reports, review specific reports, and other items.  Is your Independent Review Organization able to accommodate data management and reporting for you in a way that makes sense for your business (not the way THEY do business, but the way in which YOU do business)?

If not then it may be time for a change.  Significant improvements have been made in the way, manner, and type of data and reporting sets that can be offered.  This should be a standard feature of your relationship with an Independent Review Organization

  • How has your Independent Review Organization responded to other requests, such as after-hours accommodations, availability, and notification requests? Again, make sure that you are working with someone who will customize the review process to your organization….not the way that they do things
  • Do you receive ongoing support outside of the scope of services? Does your Independent Review Organization offer you a client liaison or account manager?  Are there regularly recurring meetings to discuss any new needs or objectives? These are all key components of customer satisfaction, make sure your needs are being met by your IRO organization

Summing It All Up

Longstanding relationships are great, as long as they continue to be as good as they once were.  In business we have a tendency to overlook reexamining longstanding relationships, especially if the contracting phase was long or arduous, or if there is no impetus for change, however by reviewing your relationship with your current Independent Review Organization you have the opportunity to ensure that you continue to get the highest quality of services for the maximum value.

Neither your organization, nor your IRO should rest on the laurels of the past way of doing business, as with all things healthcare…..improvement should be continuous.  Isn’t it time to apply the same type of thinking to your Independent Review Organization?

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