Tuesday, June 2, 2009

Outsourcing Preauthorizations For Improved Outcomes

Increasingly, medical management firms and managed care organizations are turning to Independent Review Organizations (IROs) to pre-authorize treatments at the forefront of the healthcare decision-making process. Why?

With rapid medical advances, it’s often difficult for these organizations to stay current on the latest medical necessity protocols of many treatments. Whether decisions are for long-term disease management options, such as cancer or diabetes, or for new medically approved treatments such as laser eye surgery, using an IRO in the pre-approval process can help ensure the proper care for a patient prior to the treatment taking place.

By leveraging the services of an IRO in the preauthorization process, organizations can:

Ensure medical treatment decisions are based on proven medical science Reduce the number of unnecessary, experimental and out-of-protocol treatments that increase health plan costs Gain access to specialist expertise that does not exist inside the organization so that highly informed assessments are made on each and every patient Obtain a needed buffer for cases where there might be any real or perceived conflict of interest
Improve the quality of care, by ensuring that each patient/member receives the treatment they deserve.

Cases sent out for pre-approval to an IRO tend to be complicated and cover a wide range of specialty areas. For example, surgeries traditionally categorized as cosmetic, such as orthoganathic (misaligned jaw), bariatric (obesity) or blepharoplasty (eyelid) surgeries are now often determined to be medically necessary, and therefore approved medical procedures.

The best way to ensure decisions are made accurately, timely and with confidence is to rely on the outside expertise of a third-party organization that can ensure correct treatment decisions for every patient.

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