Watchdogs Weigh In On Reviewer Independence

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.