Open public comment period for URAC's revised IRO Accreditation

Healthcare Peer Review Track Added; Performance and Reporting Measures Enhanced

URAC, a leading healthcare accreditation and education organization, today announced the open public comment period for its revised Independent Review Organization (IRO) Accreditation, version 5.0, which includes a new accreditation track for Healthcare Peer Review. As part of URAC's commitment to a comprehensive review of its standards, the organization is inviting employers, consumers, purchasers, insurers, providers, and regulators to review the revised accreditation standards, and provide feedback now through April 12, 2010.

"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.

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.