Tag: IRO

Third-Party Reviewers: Offering Streamlined Solutions for Payment Integrity

Unfortunately, the healthcare industry faces challenges with financial waste. It has been estimated that the healthcare system in the United States wastes approximately $765 billion annually, about 25 percent of what is spent. Part of this number is due to payment integrity issues such as fraud, waste and abuse (FWA). If you’re not familiar with […]

The Merits of IME and IMR

The business world is full of acronyms. Terms such as ROI (return on investment), CMS (content management system), CPL (cost per lead), KPI (key performance indicator) and API (application program interface) are discussed by many working professionals on a regular basis. Two well-known acronyms for health plans and payers are IME, otherwise known as independent […]

Evidence-Based Reporting in Independent Medical Reviews: Abounding in Benefits

Clear communication is essential in many facets of life. Whether it’s a teacher telling students about classroom rules or a physician explaining a diagnosis to a patient, providing easy-to-understand direction is important. This need for clear and open communication is evident in the healthcare industry because it can make the difference in outcomes, patient safety, […]

Independent Review Organizations (IROs) in Healthcare: An Important Part of Progress

The healthcare industry continues to be one of the fastest growing industries in the United States and is the largest source of jobs in the country. That’s not surprising as U.S. healthcare spending is approximately $3.3 trillion or $10,348 per person annually. According to the Peterson-Kaiser Health System Tracker, relative to the size of its […]

Supplemental Medical Directors

For years, the number of practicing physicians in the U.S. has not maintained pace with the rising demand for medical services. This trend has created a physician shortage, with consequences extending far beyond the doctor’s office to essential workflows throughout the American healthcare system, including the medical review process. The Association of American Medical Colleges […]

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