What laws and regulations govern an IRO?
While some states have enacted regulations that impact independent medical review (such as managed care regulations), for the most part, IROs themselves are not highly regulated. Physician licensure laws at both the state and federal levels provide a strong framework for ensuring the quality of an IRO’s determinations. However, to ensure the quality and uniformity of their services, the leading IROs have sought accreditation by URAC, a nonprofit group that audits and accredits quality measures in healthcare organizations. Some states are now requiring IROs to have URAC accreditation in order to perform independent review in their states.
