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Outsourcing Preauthorizations For Improved Outcomes
By AllMed Healthcare Management
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.
For more information on how a leading medical management firm uses AllMed to improve its preauthorization process, view our American Health Holding Case Study (http://www.allmedmd.com/resources/downloads/app_amhealth.htm)
About The Author
AllMed Healthcare Management Founded in 1995, AllMed (http://www.allmedmd.com) is a URAC-accredited Independent Review Organization (IRO) serving insurance payers, providers, TPAs and claims managers nationwide. Reviews are conducted by board-certified physicians in active practice. AllMed's growing customer base includes premier organizations, such as Educator's Mutual Life, IMS Managed Care, Tenet Healthcare Corporation, HealthGuard, several Blue Cross Blue Shield organizations, TriWest Healthcare Alliance, Allianz and many other leading healthcare payers.