Officials who keep tabs on the U.S. Department of Health and Human Services have come out with a list of actions that might compromise the independence of claim decision review organizations.
The HHS Office of the Inspector General has published advice about independent review organization independence and objectivity.
The new focus on IRO independence rules is partly a result of the Sarbanes-Oxley Act and an increased focus on issues relating to auditor independence, HHS OIG officials write in the guidance, which follows up on guidance issued in 2004.
Since the 2004 guidance was issued, the U.S. Government Accountability Office has updated its auditing standards, OIG officials note.
Officials give lists of services that an IRO might provide that likely would or likely would not impair the IRO’s objectivity.
If, for example, IRO personnel furnished general compliance training, the IRO answered a confidential problem reporting hotline or evaluated a provider’s existing compliance program, those actions probably would not affect objectivity, officials write.
If an IRO sold a billing system or coding software to a health insurer, provided specific claims review training for the insurer, developed internal control systems for the insurer, or assessed the strengths and weaknesses of the provider’s internal controls associated with the specific risk areas addressed in a corporate integrity agreement, then those types of activities probably would hurt the IRO’s objectivity, officials write.