Throughout the business world, there are various accrediting organizations whose primary role is to ensure specific standards are met and requirements are followed. For independent review organizations (IROs), it’s URAC, a Washington DC-based non-profit that helps promote healthcare quality through the accreditation of organizations involved in medical care services. 

 

Founded in 1990, URAC provides accreditation programs for companies in multiple areas of healthcare, including health plans, healthcare management, healthcare operations, pharmacy quality management, provider integration and coordination, and mental health and substance use disorder parity. Overall, it provides more than 30 accreditation and certification benchmarking products. 

 

As an independent, third-party healthcare quality validator, URAC’s accreditation process enables learning and compliance with nationally recognized healthcare standards. It also supports improvements and innovation in healthcare management and delivery. URAC demonstrates a commitment to quality services and serves as a framework to improve business processes through benchmarking organizations against nationally recognized standards. 

 Accreditation advantages for clients  

URAC standards are developed and updated by multidisciplinary expert advisory groups from across healthcare. Its accreditation reviewers consist of an all-clinician staff of nurses and pharmacists. 

 

IROs that achieve URAC accreditation voluntarily undergo a 10 to 12-month process. Most of these accreditations are awarded for a three-year period. However, only companies incorporated in the United States can apply for the accreditation.  

 

MLS Group of Companies is accredited by URAC as an independent review organization, for comprehensive reviews both internally and externally. What does that mean for our clients? According to URAC, accredited IROs: 

  • Are up to date on all federal and state regulations, organizational processes, data security and internal operations. 
  • Work with appropriately licensed and credentialed peer reviewers who are current on the latest medical standards and technologies. 
  • Ensure consistency, efficiency and accuracy in internal and external review recommendations. 
  • Are equipped to deliver three types of utilization review services: retrospective, concurrent and prospective. 
  • Provide expertise in experimental and investigational reviews, and are current on the accepted standards of care. 
  • Have immediate access to physicians and allied healthcare practitioners who are at the vanguard of medical treatments and services. 
  • Feature expansive review panels of hundreds to thousands of experts who can provide access to all recognized specialties and subspecialties. 
  • Provide advanced, ongoing education and training to ensure the use of reviewers who are knowledgeable about the most current peer-reviewed literature and evidence-based medicine. 
  • Adhere to standards and guidelines intended to avoid issues of conflict of interest. 

Our commitment to healthcare quality 

As noted by URAC, its IRO accreditation standards validate that organizations, like MLS, performing medical review services are committed to a fair and impartial medical peer review process that benefits both patients and physicians. The accreditation is “designed to assure that IROs are free from conflicts of interest, establish qualifications for physicians performing independent medical peer review, address medical necessity and experimental treatment issues, [and] have reasonable time periods for standard and expedited peer reviews, and appeals processes.” 

 

“Increased accountability regarding the proper delivery of care makes the role of independent review organizations more important than ever. By achieving independent URAC accreditation for their IRO services, MLS is proving a proficiency in providing knowledgeable and credentialed reviewers free of conflicts of interest,” said URAC President and CEO Shawn Griffin, M.D. 

 

At MLS, we offer independent medical review in a variety of areas: medical necessity, experimental/investigational, standard of care, plan language review, length of stay, quality of care, utilization, and more. We also maintain our commitment to promoting quality in healthcare. Our clients trust us, as a URAC-accredited IRO, to provide them with accurate and evidence-based reviews delivered in a timely manner.  

 

MLS also is a national provider of independent medical evaluations, FMLA medical assessments and functional capacity evaluations. We achieve success for our clients through a specialized network of physician reviewers from across the U.S. Plus, we accomplish it through a HITRUST CSF-certified platform that hosts client and reviewer portals, promoting cybersecurity in an industry often targeted by hackers and other cybercriminals. 

 

Learn more about the services we offer, and contact us to speak with one of our team members about how MLS can meet your specific review needs with exceptional client service. 
IRO accreditation: The importance of URAC standards