Healthcare Peer Review Track Added; Performance and Reporting Measures Enhanced
WASHINGTON, Feb. 25
"URAC strives to ensure its accreditation programs are meaningful across the health care spectrum," said Doug Metz, DC, Chair of URAC's Health Standards Committee and Executive Vice President and Chief Health Services Officer for American Specialty Health. "That is why the organization added two focus groups earlier this year in the standards development cycle. Listening to industry leaders and health care professionals working in the field, URAC decided to develop two tracks for its IRO Accreditation: one for healthcare peer review and one for independent review organizations."
The new dual accreditation tracks have been developed to help organizations ensure compliance with the processes established by the National Association of Insurance Commissioners (NAIC) regarding the transmission of external review information between health insurers, external review agents and state regulatory bodies.
Revisions to the accreditation standards address performance monitoring and reporting requirements for organizations. Definitions have also been added for key terms to help ensure consistency. Another change, the Healthcare Peer Review (HPR) Accreditation, allows companies performing both IRO and peer review functions to complete a single, streamlined accreditation application. In addition, the new standards require that all clinical reviewers who conduct an independent review attest that they do not have a conflict of interest with the case, ensuring an additional layer of consumer protection.
"The Model Act was the first step in developing a national standard and uniform approach for processing, conducting, and making external review determinations," said Gib Smith, Executive Director of the National Association of Independent Review Organizations (NAIRO). "URAC takes the next step by providing clear independent quality standards to guide companies through the steps toward compliance and reduce the oversight burden on state regulators."
Though all types of review share some common structure and processes, "internal review" and "external review" diverge when addressing issues such as peer reviewer qualifications and conflicts of interest. In particular, internal review supports the internal peer review and appeal process for health plans, where standards addressing peer-to-peer conversation apply, but are otherwise inappropriate for an independent external review, and where a peer reviewer cannot handle a case more than once. The URAC standards help organizations navigate these differences in their move towards compliance.
"These new revisions offer even more guidance to help organizations meet the standards of the NAIC Model Act. URAC accreditation ensures a fair and impartial review process that benefits both patients and physicians," said Joyce Muller, President and CEO of IMEDECS, a NAIRO member organization.
Revisions to URAC's Independent Review Organization (IRO) Accreditation program standards, version 5.0, are available for review and comment at http://www.urac.org/publiccomment/. Comments will be accepted through Friday, April 12, 2010. After public comment, additional revisions will be made. Final standards could be approved by URAC's Board of Directors as early as July 2010.
URAC, an independent, nonprofit organization, is well-known as a leader in promoting health care quality through its accreditation, education and measurement programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system, and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry. For more information, visit www.urac.org.
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