Established in 1996, one of the MLS Group of Companies’ key roles is that of an independent review organization (IRO). IROs are defined as third-party medical review resources, which provide objective, unbiased determinations that support effective decision-making based only on medical evidence. Many IROs provide multiple services, such as utilization and peer reviews and independent medical examinations (IMEs).

Numerous types of health care organizations utilize IROs, including:

  • Third party administrators (TPAs)
  • Hospitals
  • Reinsurers or stop-loss carriers
  • Disability insurance carriers
  • Large self-insured corporations that pay and oversee their own health care benefits
  • Workers’ compensation carriers
  • Managed Care Organizations (MCOs)
  • Property and casualty firms that are paying out medical claims
  • Utilization review and medical management firms
  • Fraud units working inside larger health plans and special investigative units

Perks Provided by IROs

In addition to adhering to strict compliance requirements, including mandates for DOL/ERIS, top IROs have the capabilities and resources to deliver quick turnaround times and meet the appropriate state and federal guidelines and recommendations. They’re able to offer unbiased decisions, eliminate conflicts of interest and ensure that each party is treated fairly through a resolution based solely on clinical documentation.

By streamlining the process of medical review, IROs provide health care entities with a reliable resource that has a positive impact on health plan review processes and other management activities. These health care organizations also benefit from reduced liability through the utilization of external, Board-certified specialists in the same or similar field of service as the original provider(s).

Outsourcing medical reviews to a certified IRO frees up in-house medical directors to focus on other core business objectives, while giving them a cost and time-effective resource to handle reviews when their organization has an overflow of cases. IROs that use advanced technology to augment their processes are able to more quickly complete reviews, thereby boosting both client and member satisfaction.

Tips on Picking the Right IRO for Your Organization

Selecting the IRO that best meets your business objectives is essential. The choice shouldn’t be based solely on cost.

For example, employing the services of an IRO that has achieved accreditation from the Utilization Review Accreditation Commission (URAC) is crucial. URAC’s IRO accreditation standards “validate that the organizations performing IRO services are committed to a fair and impartial medical peer review process that benefits both patients and physicians.” MLS is a URAC-accredited national provider of independent medical evaluations, Family Medical Leave Act (FMLA) assessments and functional capacity evaluations.

Benefits of URAC’s IRO Accreditation include:

  • Third-party validation that your high-quality program can help improve patient care while avoiding unnecessary procedures with no inherent benefit
  • Enhanced credibility that your licensed and credentialed peer reviewers are current on the latest standards, peer-reviewed literature and evidence-based medicine, as well as emerging technologies
  • Risk management oversight and review protocols that protect patient rights, reduce client liabilities, enhance data security and ensure regulatory compliance
  • A blueprint for ongoing operational efficiency, advanced reviewer education and training and program oversight

It’s also important to opt for an IRO that is staffed with experts who are clinically knowledgeable, even in specialty areas. A reliable IRO uses physician matching, which ensures reviews are managed with the highest level of knowledge and expertise using widely accepted criteria, and offers immediate access to physicians and allied health care practitioners who are leaders in medical treatments and services.

At MLS, our doctors are active in medical practice, stay up-to-date on the latest evidence-based studies and services in their field of specialty and undergo a thorough credentialing process.

The MLS Commitment

At MLS, we offer peer review services in workers’ compensation, group health and disability to serve TPAs, insurance carriers, utilization review organizations, hospitals, state and federal agencies and more. We’re recognized as a national IRO for our experience and commitment to providing exceptional client service, objective medical assessments and the protections and swift turnaround times ensured through our secure client portal. Plus, our platform and portal are HITRUST CSF-certified, demonstrating our commitment to maintaining the highest standards for healthcare cybersecurity. Contact us to learn more!

A Guide to Independent Review Organizations (IROs)