Should an Independent Reviewer’s Identity be Disclosed?

Should an Independent Reviewer’s Identity be Disclosed?

Mention reviewer anonymity and you’ll uncover strong opinions for and against the practice. It’s hard to find a middle ground on the matter of whether to reveal an independent reviewer’s identity. And even though the Centers for Medicare and Medicaid Services (CMS) do not permit insurers to “provide financial incentives to Independent Review Organizations (IRO) based on the likelihood that the IRO will support the denial of benefits,”[1] when a denied claim enters into external review, many times the consumer demands to know the reviewer’s identity.

Incidents of threats and harassment against reviewers, including actions against reviewers’ medical licenses, makes reviewers reluctant to reveal their identities. When reviewers are faced with forced disclosure, many either decline to review appeals or demand higher fees for their services.

IROs Favor Anonymity

To maintain the overall quality and integrity of the independent review, IROs favor withholding a reviewer’s identity unless required by contract, statute or law. IROs maintain that keeping a reviewer anonymous allows the reviewer to make the most appropriate decision without undue influence from potential stakeholders.

Consumers and Providers Request Disclosure

Consumer advocates and healthcare providers have countered that disclosing a reviewer’s identity provides additional transparency in the review process. In fact, many treating or attending healthcare providers have disclosed reviewers’ identities to stakeholders, including the insured.

In an effort to satisfy all interested parties, some IROs provide a “blinded” biography of the reviewer that includes credentials such as board certifications, licensure, years of experience and areas of expertise. By doing so, the IRO argues it is presenting the pertinent information without disclosing the specific information about the individual reviewer.

Balancing the interests of consumers, payers and reviewers is a delicate act. The pros and cons of securing or disclosing a reviewer’s identity will continue to be debated by policymakers and stakeholders.

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[1] https://marketplace.cms.gov/technical-assistance-resources/internal-claims-and-appeals.pdf