By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    stress management for healthcare workers
    3 Tips For Healthcare Professionals: How To Stay Beautiful, Healthy, and Happy
    November 2, 2021
    importance of relaxing on the weekend for your health
    Importance of Relaxing During the Weekend for Optimal Health
    March 25, 2022
    LASIK Eye Surgery
    What Is LASIK Eye Surgery?
    May 16, 2022
    Latest News
    7 Most Common Healthcare Accreditation Programs: Which Should You Use?
    August 20, 2025
    Hospital Pest Control and the Fight Against Superbugs
    August 20, 2025
    Hygiene Beyond The Clinic: Attention To Overlooked Non-Clinical Spaces
    August 13, 2025
    5 Steps to a Promising Career as a Healthcare Administrator
    August 3, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    All That You Need to Know About Clenbuterol
    November 22, 2019
    Top 5 Facts About CPPA Accreditation
    April 9, 2015
    mental health benefits school
    Mental Health & Practical Benefits of Continuing Education After 30
    June 30, 2024
    Latest News
    How Social Security Disability Shapes Access to Care and Everyday Health
    August 22, 2025
    How a DUI Lawyer Can Help When Your Future Health Feels Uncertain
    August 22, 2025
    How One Fall Can Lead to a Long Road of Medical Complications
    August 22, 2025
    How IT and Marketing Teams Can Collaborate to Protect Patient Trust
    July 17, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: 5 Ways IROs Can Increase Your ROI
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Business > 5 Ways IROs Can Increase Your ROI
Business

5 Ways IROs Can Increase Your ROI

Abby Norman
Abby Norman
Share
6 Min Read
ROI, IROs, peer review, healthcare
SHARE

ROI, IROs, peer review, healthcareIROs can help control costs and save you money (and resources) when it comes to all sorts of claims, not just medical necessity; and if you’re stuck trying to choose one, there are plenty of online resources to help you out! Take a look at our free white paper “Mitigating Risk Through External Peer Reviews” for more insight into the IRO world.

Contents
  • 1. Saving You Money
  • 2. Evolving Practices, Policies & Procedures
  • 3. Hyper-Specialization
  • 4. An Evidence-Based Approach
  • 5. Other IRO benefits worth mentioning?
  •  

ROI, IROs, peer review, healthcareIROs can help control costs and save you money (and resources) when it comes to all sorts of claims, not just medical necessity; and if you’re stuck trying to choose one, there are plenty of online resources to help you out! Take a look at our free white paper “Mitigating Risk Through External Peer Reviews” for more insight into the IRO world.

1. Saving You Money

When we talk about outsourcing, the first defense that’s likely to surface is, “won’t that cost more money?” Hospitals frequently make the mistake of assuming that by conducting claim reviews in house they are automatically saving money. This illusion is understandable, since it’s long been the belief in many industries that the more you can do for yourself, the less money you have to spend hiring someone else to do it.

When it comes to reviewing claims, however, trying to manage denials in house can be counterproductive when it comes to saving money. While you would naturally assume that having your own organization’s staff review your claims, whom are of course already paid staff, would be the most cost-effective claim management arrangement, this is actually unlikely to be the case.

More Read

CEO’s Sleep: How Many Hours do Entrepreneurs Sleep?
Health Start-Ups! – Beddit Does It Right
Long Term Services and Supports Scorecard
Give Your Facts a Facelift with Integrated Infographics
How Many Patients Should a Primary Care Physician Care For?

2. Evolving Practices, Policies & Procedures

As medicine, as an industry, has continued to evolve and the advancements within various disciplines have been accelerated by technology, so to increases the specialization within the industry. In order to remain relevant, stay “up to speed” on the newest technology, treatments and protocols, even specialists find themselves having to further specialize in order to remain competitive. The aggressive narrowing of fields, however, makes the knowledge gap between providers even larger and creates a knowledge chasm between providers and those who are tasked with reviewing claims associated with the treatments they proffer.

3. Hyper-Specialization

While it may be true that someone reviewing claims within your organization would be aware of the broader vision and operations of providers, it’s unlikely that they would be able to accurately asses for medical necessity within these hyper-specific disciplines unless they were within that area of expertise themselves. Hiring, training and retaining specialists would be a costly investment for any hospital, and as the disciplines continue to fragment into even more precise practices, there could be an infinite need for these professionals. That’s where IROs come in.

IROs are tasked with the hiring and training of specialists who can review claims and determine whether or not the denial was valid. They provide an invaluable service: an unbiased yet educated review of the claim, something which is only possible because they are independent of the organization they are reviewing.

4. An Evidence-Based Approach

Working hand-in-hand with URAC’s standards IROs are able to take an evidence-based approach to evaluating claims – and it’s not just medical necessity: they can provide reviews for pharmacy, disability, hospitals and worker’s compensation. Why outsource this work? Outsourcing reduces cost and improves quality simultaneously. Since IROs are designed to fulfill the review function, they can process far more claims in a given time frame than an organization could on its own, which saves time and time is money!

5. Other IRO benefits worth mentioning?

  • Standard set criteria guides decision-making
  • A large pool of experts who have varied professional experience
  • Unbiased assessment
  • Reviewers from all over the United States available
  • Frees up medical directors and other administrators to concern themselves more with the tasks at hand that affect direct patient care and carry less administrative burden
  • Pertains to medical necessity – of particular importance with the coming of ICD-10
  • Providing clarification and necessary exceptions to cases that deviate from the norm – example? Cosmetic surgery would normally not be medically necessary, but in some cases, such as in reconstructive surgeries that restore function, they would be classified as necessary.
  • Find yourself on the cusp of new technology, research and the very best medical care available.
  • Know that you are compliant at state and federal leaves.

 

The post 5 Ways IROs Can Increase Your ROI appeared first on BHM Healthcare Solutions.

Share This Article
Facebook Copy Link Print
Share
By Abby Norman
My name is Abby Norman and I am a healthcare blogger. With over 10 years of experience in the medical field, I have developed a passion for helping others understand the complexities of healthcare.

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

engineer fitting prosthetic arm
How Social Security Disability Shapes Access to Care and Everyday Health
Health care
August 20, 2025
a woman explaining the document
How a DUI Lawyer Can Help When Your Future Health Feels Uncertain
Public Health
August 20, 2025
physiotherapist at work
How One Fall Can Lead to a Long Road of Medical Complications
Health care
August 20, 2025
Common Healthcare Accreditation Programs
7 Most Common Healthcare Accreditation Programs: Which Should You Use?
Health News
August 20, 2025

You Might also Like

Why Is There a Problem with Health Care Quality?

April 13, 2011

What is a Healthcare Innovation Really Worth?

July 31, 2012
medicalperson
BusinesseHealthSocial Media

Patient Engagement: From Idea to Proof

August 11, 2014

The Incredible Shrinking Small Business Health Insurance Tax Credit

May 20, 2011
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?