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How Case Managers Can Get the Most from an Independent Review Organization

June 16, 2005 -- AllMed Healthcare's Dr. Skip Freedman has written an article entitled "How Case Managers Can Get the Most from an Independent Review Organization" which was published in The Case Manager, volume 15, issue 6, November 2004. To read a full copy of the article, please click on the following link: http://www.allmedmd.com/company/download/cm_iro.htm



In the article, Dr. Freedman outlines the benefits for using Independent Review Organizations for Independent Medical Reviews and lists for case managers situations where using an Independent Review Organization would either be beneficial or legally required. Examples where and Independent Medical Review would be beneficial include pre-authorization, fraud, determination of medical necessity, and experimental / investigational procedures.



Independent Review Organizations make objective third-party medical review determinations based upon objective medical facts. Too often, claims managers lack the necessary information to make an objective medical claims decision within an acceptable timeframe and, as a consequence, the organization might end up paying out large claims that need not be paid. Outsourcing such medical claims decisions to an Independent Review Organization can result in tremendous savings to the payer. An Independent Review Organization can also determine whether a less expensive course of treatment can meet the medical needs of a patient. Due to the objective nature of these Independent Medical Reviews, appeals of denied medical claims are very rare and medical management companies, insurance companies, and employers can realize significant savings by using Independent Review Organizations for their more complex claims.



To read Dr. Freedman's article in its entirety, please click on the following link:

http://www.allmedmd.com/company/download/cm_iro.htm

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