|
CIMRO Registered by the Illinois Department
of Insurance as an External Independent Review Organization (EIRO)-
July 2010
CIMRO, a URAC accredited
Independent Review Organization, was granted a license to conduct
external independent reviews of adverse determinations made by fully
insured individual and group major medical health insurance carriers
and HMOs for all insured residents of Illinois. CIMRO was one of
only six IROs nationwide to be approved by the Illinois Department
of Insurance during the initial registration process.
http://insurance.illinois.gov/EIRO/eirolist.asp#eiro
Effective beginning July 1, 2010, the Health Carrier External Review
Act (the “Act;” P.A. 96-857) grants all Illinoisans with health
insurance the right to an external, independent review of denied
health insurance claims. Tina Georgy, RN, MS, Chief Executive
Officer stated, "CIMRO is delighted to provide this assistance to
the Illinois Department of Insurance. This process allows insured
persons in Illinois the right to have a medical expert with no
connection to their health plan review the health plan's decision.
We have provided peer review assistance in Illinois since 1972 and
we have have been registered in Illinois as Utilization Review
Organization since 2000, when that requirement was first
implemented. We look forward to our continued relationship with the
Department as a registered EIRO."
For details on how CIMRO can assist health plans and utilization
review organizations in meeting these requirements, contact Jennifer
Kirkland, RN, BS, CPHQ, Project Manager at
jkirkland@cimro.com or call
1.800.635.9407 ext.4202.
Published
Article on Peer Review
CIMRO’s Medical
Director, Barry Slotky, MD and Project Manager, Judy Kinkelaar Ring, RN,
BSN recently coauthored an article, Independent Review Supports
Transparency that was published in ABQAURP’s Patient Safety
& Quality Healthcare Journal. Click here
for a link to the article.
CIMRO Awarded Independent Peer Review Contract with Multi-Hospital
System:
Spring 2008 - CIMRO recently signed a contract with
a large multi-hospital system to provide independent peer review services to
its facilities. The system is one of the nation's largest hospital companies focused on non-urban
care, with facilities in 18 states.
Cases are selected by each facility and forwarded to CIMRO, where reviews are conducted by board certified physicians who match the specialty of the care under review. CIMRO physician reviewers provide an unbiased opinion regarding the care rendered, which is based on documentation in the medical record.
CIMRO Awarded Strategic Service Partner Contract from QHR
CIMRO became a QHR Strategic Service
Partner in June 2007. QHR is a Family of Brands that has provided consulting, management and education resources to hospitals and health systems for three decades. QHR is the dominant market leader in hospital management resources, with nearly 200 current multi-year clients in 39 states across the U.S.
QHR’s Strategic Service Partner (SSP) Program provides its hospital clients with access to specialized services. An SSP must undergo a stringent identification and selection process to ensure its vision and values are compatible with QHR and that its products or services offer clients high quality and great value. SSPs must demonstrate:
 A proven track record;
Consistently strong financial performance;
A demonstrated commitment to business ethics; and
A national or regional presence to support all QHR hospital clients.
CIMRO provides independent peer review to assist facilities with their internal QI activities to mitigate conflict of interest concerns (e.g., practitioners in direct competition or within the same practice, too few practitioners in a specialty, etc.) when an unbiased review by a peer is not possible; ensure adherence to quality standards; reduce liability risk; and meet regulatory, credentialing, and accreditation requirements.
Services include the full range of review/oversight activities, including sentinel/adverse event reviews, mortality reviews, medical imaging/diagnostic and interventional cardiology/sleep study overreads, antibiogram reviews, pattern of care reviews, experimental/investigational determinations, fair hearing expertise, peer review-related education, and Critical Access Hospital oversight and monitoring.
Independent Peer Review Contracts
As noted on the map below, CIMRO performs independent review services in
42 states. Independent peer review is requested by clients for periodic review and receipt of an objective opinion on the quality of medical services rendered by providers. Patient-specific records and current standards of practice for the diagnosis and treatment involved are utilized in making a determination. National clinical guidelines and peer-reviewed literature are also considered in the reviewer’s decision-making process. CIMRO provides a detailed report to the client regarding the findings of each case within 30 calendar days of the request. Expedited reviews may be conducted upon request. Additionally, we provide such services as onsite or telephonic educational sessions and peer-to-peer discussion, specialty reviews (patterns of care, antibiogram, mortality, etc.), and we participate in onsite fair hearings, when requested. CIMRO has
nearly 700 credentialed peer reviewers in every major specialty and sub-specialty available to conduct independent peer review.
CIMRO Awarded Critical Access Hospital Quality Oversight Contract
CIMRO was awarded a quality oversight contract with a Missouri Critical Access Hospital to assist the CAH in meeting Federal Conditions of Participation. As part of the contract CIMRO reviews the CAH’s policies and procedures related to patient care, evaluates the CAH’s quality improvement program and plan and makes recommendations for improvement, reviews a sample of medical records for validation of documentation requirements, and conducts onsite visits to the
CAH, interviewing staff, observing daily hospital activities, and verifying the CAH's compliance with its policies and Federal and State regulations.
CIMRO Receives URAC Re-accreditation
URAC, an independent, nonprofit organization, is a leader in promoting health care quality through accreditation and certification programs. URAC's standards keep pace with the rapid changes in the health care system and provide a mark of distinction for health care organizations to demonstrate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all stakeholders are represented in setting meaningful standards for the health care industry. For more information, visit
www.urac.org.
CIMRO assists health care organizations in 42 states with accreditation/regulatory, quality improvement, and credentialing activities. Hospitals and other health care facilities seek CIMRO’s peer review services in order to support their internal quality activities.
About
Us | Independent Peer
Review | Quality
Management | Medicare
| Utilization/Case Management
| Site Map
| Home |
Contact Us |
Privacy Policy
|
