Customers particularly value our work as an Independent Review Organization (IRO).
IRO services include:
- Appealing denials/rejections from third party payers
- Developing a response to take-backs and recoupment proposed by government or other payers
- Defending providers in payer audits
- Providing oversight, review, and compliance reporting to the Office of Inspector General on behalf of providers subject to a Corporate Integrity Agreement.
The above services rely upon the capabilities of our credentialed staff in determining applicable standards and applying these standards to various clinical services. This may include review of documentation, analysis of CPT and diagnostic codes, review of payer contracts, summarizing guidance from CPT Assistant, reviewing Correct Coding Initiative edits, identifying Medicare Local Coverage Determinations as well as Medicare national policy, and peer group analysis.