Independent Review Organization (IRO)

An increasing number of healthcare organizations count on RR Health Strategies (RRHS) to help ensure their compliance program is fulfilling their Corporate Integrity Agreement (CIA) obligations. We help anticipate—and address—potential compliance risks, mediate between the organization and regulators, conduct compliance reviews and assist in report preparation.

RRHS provides:

  • Expertise in the relevant substantive matters.
  • Proficiency in general requirements of the relevant federal healthcare programs.
  • Appropriate credentials/certifications.
  • Knowledge of statistical sampling (if applicable).
  • The resources to perform the work on a timely basis in accordance with CIA deadlines.

Organizations choose RRHS to:

  • Ensure their compliance program meets CIA obligations.
  • Support their healthcare decisions.
  • Meet state and federal mandates.

Working as an IRO, we:

  • Create a standardized process through which organizations can easily navigate their right to multiple levels of determination appeals.
  • Motivate adherence to time lines, and thus avoid penalties from overturned rulings due to administrative errors.
  • Provide evidence that your organization is keeping current with quality benchmarks and best practices.

While most IRO audits also include a claims review, there are times we might simply conduct a verification review or perhaps act in the much more extensive role of quality monitor as a result of a CIA. When we assist in the claims review process, it involves three phases:

  1. The preparation work required prior to the on-site visit or the off-site claims review.
  2. The actual on-site review or the off-site review of claims.
  3. The analysis of the claims review results and the preparation of the IRO report.

RRHS case reviews combine an evidence-based evaluation of the treatment in question with an expert opinion to address questions of experimental/investigational status, medical necessity and appropriateness.

Put RRHS' experience in IRO Consulting to work for your organization. Contact us.