IRO review definition
Examples of IRO review in a sentence
The IRO shall prepare a report based upon each IRO review performed (IRO Review Report).
For each Reporting Period, the OIG shall have the discretion to identify up to 50 physicians or Related Entities from the applicable Physician Payment Listing that will be subject to the IRO review described below.
If the OIG elects to exercise this discretion, it shall notify the IRO of the physicians and/or Related Entities subject to the IRO review.
For each IRO Reporting Period, the OIG shall have the discretion to identify up to 50 physicians or Related Entities from the applicable Physician Payment Listing that will be subject to the IRO review described below.
Each IRO review shall also include a review of up to three additional areas or practices of Indivior identified by OIG in its discretion (hereafter “Additional Items”).
If the OIG elects to exercise this discretion, it shall notify the IRO at least 90 days prior to the end of the IRO Reporting Period, of the physicians and/or Related Entities subject to the IRO review.
No later than 120 days prior to the end of the applicable Reporting Period, the OIG shall notify Indivior of the nature and scope of the IRO review to be conducted for each of the Additional Items.
For purposes of identifying the Additional Items to be included in the IRO review for a particular Reporting Period, OIG will consult with Indivior and may consider internal audit and monitoring work conducted by Indivior, the Government Reimbursed Product portfolio, the nature and scope of Indivior’s promotional and other practices, the nature and scope of Indivior’s arrangements with HCPs and HCIs, and other information known to OIG.
If the OIG elects to exercise this discretion, it shall notify the IRO, at least 90 days prior to the end of the Reporting Period, of the physicians and/or Related Entities subject to the IRO review.
If you request that an IRO perform an expedited review simultaneously with the insurer’s review and your request is eligible for an IRO review, the IRO must also provide its expedited decision within 72 hours after receiving the necessary release of information and related records.