IPRO has earned accreditation as an Independent Review Organization (IRO) by the nationally recognized URAC organization. IROs conduct impartial, independent reviews of appeals of health plan decisions lodged by patients and their representatives or providers. IPRO currently conducts these reviews in 16 states and the District of Columbia. “We are grateful for this honor,” notes IPRO Senior Director Terese Giorgio, BSN, MA, RN, LNC. “This certification is from the universally recognized authority in this area.” IPRO utilizes a panel of over 300 board-certified, clinical peer reviewers to conduct IRO reviews as well as a team of contract attorneys. Clinical experts are credentialed and subsequently re-credentialed every three years. Read the rest of this entry »
IPRO has been chosen by the State of New York to examine utilization of the state’s Early Intervention (EI) program, which provides therapeutic and supportive services to children with disabilities, age birth through two years, and their families.
Under the program, all eligible children receive multidisciplinary evaluations, including assessment of cognition and communication as well as social-emotional, physical and adaptive development. Eligible children and families are then assigned to case managers. Providers include incorporated entities, partnerships and agencies as well as licensed individuals. New York’s is the nation’s largest EI program, with more than 74,000 eligible children and families at an annual cost of about $700 million. Read the rest of this entry »
IPRO and Univision radio have scheduled a “Diabetes Wellness Workshops Graduation” event to be held November 10 at the Betances Community Center in the Bronx. More than 200 Hispanic and African American seniors are scheduled to take part in the recognition program, which will include a self-care teach-in, musical entertainment and a dance class. The event is being held in conjunction with American Diabetes Month. Co-sponsors include the American Diabetes Association, New York City’s Department for the Aging and the New York City Housing Authority. For more information, contact IPRO Project Manager Janice Hidalgo at (516) 209-5310 or send an e-mail to email@example.com.
The medical loss ratio recommendations recently sent to HHS by the National Association of Insurance Commissioners (NAIC) spell out the quality improvement expenses regulators believe ought to be recognized as direct care rather than administrative expenses to health plans. Under health reform, the Secretary of HHS is tasked with promulgating uniform cost definitions for health plans beginning in 2011, based on the recommendations of NAIC. The Commissioners propose that quality improvement expenses be limited to the broad goals of improving outcomes and reducing disparities, preventing hospital readmissions, improving safety and reducing medical errors, increasing wellness and enhancing the use of data to improve quality, transparency and outcomes. For each of these goals, NAIC outlines the specific strategies it would approve. Read the rest of this entry »
The vast majority of the growth in hospital admissions in New York State is attributed to patients with either a primary or secondary diagnosis of diabetes, according to a white paper released this fall by the New York State Health Foundation and the Healthcare Association of New York State. For 2000 through 2008, fully 84% of the growth in admissions to New York hospitals (137,000 of a total of 163,000 new cases) was for patients with diabetes, according to a review of state and federal data bases. In terms of readmissions, researchers find diabetics are 1.6 times more likely to be readmitted to a New York hospital than other patients and this holds true regardless of payer source. Read the rest of this entry »
States have until December 31 to indicate whether they plan to contract with one or more Medicaid “Recovery Audit Contractors” (RACs), according to an October 1 directive to State Medicaid Directors from the Centers for Medicare & Medicaid Services (CMS). The federal health reform law designates Medicaid RACs as contingency-fee based contractors, similar to the four Medicare RAC contracts now in place nationwide. Contractors will be tasked with identifying underpayments and recouping overpayments. States will be required to have programs in place to guard against overlapping audits by different contractors or agencies. Additionally, states will have to develop procedures to assure that instances of suspected fraud or abuse are forwarded to State Medicaid Fraud Control Units on a timely basis. The Medicare RAC experience demonstrates that overpayments exceed underpayments by a ratio of 9:1, according to officials. The directive states that federal financial participation (FFP) in contingency fees will be capped at the rate of 12.5 percent. CMS says it expects to waive state participation in Medicaid RAC programs “rarely and only under the most compelling of circumstances.”
Hospital-acquired infections remain the cause of extended hospitalizations, and even death, for thousands of patients nationwide every year. They merit every hospital’s attention and effort.
A range of healthcare organizations have coalesced around this issue in an effort to improve patient safety by reducing post-surgical complications. Ten national healthcare organizations are spearheading the effort, including the Centers for Medicare & Medicaid Services (CMS), American College of Surgeons, American Society of Anesthesiologists and American Hospital Association, among others. Read the rest of this entry »