100%
Healthcare-Focused
30+
Years Experience
End-to-End
IRO Support
IROs for Healthcare Compliance
What is an Independent Review Organization (IRO)?
An Independent Review Organization (IRO) is a neutral third party that runs reviews and makes objective, evidence-based medical determinations.
Working with an IRO can help ensure you’re meeting obligations to improve compliance and prevent fraud as outlined in your Corporate Integrity Agreement (CIA) with the Office of Inspector General (OIG).
Strategic Management Services takes a thorough approach and streamlines the process to make it easy and effective for our clients. Not only do we offer healthcare-specific IRO services such as claims reviews and evaluating compliance,but we also run mock IRO reviews to help you prepare with confidence.
Why Are Independent Review Organizations (IROs) Important?
3 Reasons to Partner with an IRO
Meet Your CIA Obligations
The input of an IRO is an essential component of most CIAs or Integrity Agreements (IAs), validating key compliance areas, such as arrangements with referral sources, and insurance claims to settle disputes with the OIG.
Identify and Address Compliance Gaps
Through detailed reviews of billing practices, referral arrangements, and internal controls, an IRO can uncover potential compliance vulnerabilities before they escalate into larger issues. This proactive insight allows organizations to remediate risks and strengthen their overall compliance posture.
Support Ongoing Compliance Program Improvement
Beyond meeting specific agreement requirements, IROs offer actionable recommendations that help organizations refine policies, procedures, and monitoring activities. This expertise supports continuous improvement, ensuring your compliance program evolves alongside regulatory expectations.
Struggling to Meet Your CIA Obligations?
What Does an Independent Review Organization Do?
Comprehensive IRO Services
- Arrangements Reviews
Determine if your arrangements comply with the Anti-Kickback Statute, the Stark Law, and CIA requirements, all based on regulatory expertise. Our consultants conduct reviews of arrangements between your healthcare organization and its practitioners, suppliers, vendors, and other healthcare providers. - Claims Reviews
Evaluate your claims to ensure they are in accordance with federal healthcare coding and billing requirements. Our team uses a sampling strategy developed based on the OIG’s approved RAT-STATS methodology to make claims reviews accurate and efficient. - Systems Review
Verify the compliance of all systems that track, monitor and verify claims, arrangements, pricing, and marketing and sales activities. Our consultants review your systems, including claims processes, policies, and procedures, using expert knowledge of governing Federal requirements and standards. - Transaction Reviews
Ensure your transactions are not at risk of non-compliance with the Anti-Kickback Statute, Stark Law, or CMS program coverage. Our statistics experts select samples of transactions to be reviewed in accordance with OIG RAT-STATS and CMS Program Integrity standards. - Unallowable Costs Review
Our consultants review unallowable costs included in a health care organization’s cost reports or claims submitted to Federal health care programs. We then determine if unallowable costs were reported and adjusted and ensure they are not included in the future cost report or claims. - Marketing Practices Reviews
Determine whether your marketing practices meet Federal healthcare program requirements. Our consultants examine marketing practices carried out by pharmaceutical or device manufacturers, managed care organizations, and other types of health care organizations engaging in marketing practices with federal healthcare beneficiaries. - Secret Shopping & Compliance Reviews
Establish whether your organization conducts its marketing or enrollment practices in accordance with Federal requirements. We complete these reviews in two ways:- Monitoring marketing practices of pharmaceutical and device manufacturers and marketing and enrollment practices of managed care organizations.
- Conducting secret shops by posing as a Medicare or Medicaid eligible beneficiary seeking information about or enrollment with the organization.
Work with a Trusted IRO to Meet Your CIA Obligations
Book a consultation to explore how our team could protect your organization.
