Independent Review Organization
Weatherbee Resources can serve as your Independent Review Organization (IRO) for the purpose of reviewing all the data elements that substantiate your hospice's compliance with the Corporate Integrity Agreement (CIA) and evaluating the eligibility of patients to elect the Medicare/Medicaid Hospice Benefit.
A CIA between your hospice and the Office of Inspector General (OIG) governs the terms and activities associated with IRO-related consultations.
Weatherbee's IRO services can include:
- Reviewing the CIA and all data elements necessary to substantiate the hospice’s compliance with its CIA
- Formulate and implement a written plan and schedule to accomplish required activities for each Reporting Year
- Auditing clinical records and reporting findings on an annual basis
- Reviewing records to determine initial and ongoing eligibility for the hospice benefit and whether the claim to Medicare was properly documented, submitted, and paid
- Conducting a review of compliance with unallowable cost provisions of the Settlement Agreement
- Preparing and submitting reports of findings of reviews, with supporting rationale, and whether obligations have been met
- Conducting a review of systems used to determine and document eligibility for the hospice benefit, including the processes for certification and recertification
- Participating in scheduled conference calls with legal counsel, the Centers for Medicare and Medicaid Services, the OIG, and/or others as requested by the hospice
Weatherbee customizes IRO services to evaluate and validate the specific issues cited in the hospice's CIA.
Engaging Weatherbee will result in:
- Reviewing the practices, processes and systems identified in the IRO;
- Evaluating staff and systemic corrections designed to resolve IRO-related issues; and
- Validate the ongoing compliance with the CIA.
Please contact Weatherbee for additional information regarding Independent Review Organization needs.