What does an IRO do?

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Most Corporate Integrity Agreements (CIA) require that a claims review be conducted by an Independent Review Organization (IRO) or in some cases, the provider may perform the claims review and the IRO conduct a verification review.

The Fox Group will work with the provider to fulfill the requirements of the CIA as they pertain to the duties of an IRO.  In most cases, this means that during our IRO audits we will perform a claims review but at times it might simply be a verification review or perhaps the much more extensive quality monitor role.  Plus, there are other activities that an IRO will perform as a result of a CIA.  Since we have experience as an IRO, we can assist the provider in the claims review process which will usually involve three phases:

  • Phase one involves the preparation work required prior to the onsite visit or the offsite claims review.
  • Phase two encompasses either the actual onsite review or the offsite review of claims.
  • Phase three involves the analysis of the claims review results and the preparation of the IRO report.

Next: Where does the IRO do its work?

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