The Two-Midnight Rule: Changes For 2016

The Two-Midnight Rule: Changes for 2016

  • February 1, 2016

Medical Necessity Documentation Still Required Have you heard the news? In the 2016 Outpatient Prospective Payment System Final Rule the Centers for Medicare & Medicaid Services (CMS) has modified the two-midnight rule evaluation and enforcement process. The “probe and educate” period ends on January 1, 2016. Enforcement of the rule will be the responsibility of the two BFCC Quality Improvement Organizations (Livanta and KEPRO). Their charge is to evaluate the appropriateness of short-stay inpatient admissions that extend over less than two midnights. Both BFCC Quality Improvement Organizations (BFCC-QIOs) will use InterQual as a decision support tool to help evaluate whether…

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Livanta Selects InterQual To Support Its Medicare Utilization And Quality Care Reviews

Livanta Selects InterQual to Support its Medicare Utilization and Quality Care Reviews

  • January 28, 2016

Today we announced that healthcare services company Livanta licensed InterQual after becoming the Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) for Centers for Medicare & Medicaid Services (CMS) Areas 1 and 5. Livanta signed a long-term agreement to use InterQual for utilization and quality reviews for Medicare beneficiaries, including short-stay inpatient status claims reviews. Livanta is one of only two BFCC-QIOs charged by CMS to audit short-stay claims. Read the news release

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KEPRO Extends Use Of InterQual To Support Clinical Excellence In Utilization And Quality Reviews

KEPRO Extends Use of InterQual to Support Clinical Excellence in Utilization and Quality Reviews

  • January 25, 2016

Today we announced that KEPRO (Keystone Peer Review Organization, Inc.) will continue its use of InterQual for utilization and quality reviews. KEPRO is one of only two Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIOs) charged by the Centers for Medicare & Medicaid Services (CMS) to audit short-stay claims. As part of the new long-term agreement, KEPRO will use InterQual for review of two-midnight short stays on behalf of CMS, in addition to quality reviews for its state Medicaid contracts and commercial lines. Read the news release

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The Military Health System Selects InterQual For Utilization Management

The Military Health System Selects InterQual for Utilization Management

  • January 21, 2016

Today we announced the Military Health System has signed an agreement for its Military Treatment Facilities (MTFs) to use InterQual®, an evidence-based clinical decision support tool. Award of this contract will support MTF accessibility to this tool in approximately 55 inpatient military hospitals and 373 ambulatory care clinics around the world. Read the press release

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New McKesson ClaimsXten Solutions Help Payers Of All Sizes Streamline, Automate, And Scale Value-Based Reimbursement

New McKesson ClaimsXten Solutions Help Payers of all Sizes Streamline, Automate, and Scale Value-Based Reimbursement

  • January 19, 2016

  Today we unveiled two next-generation solutions in our market-leading claims editing technology portfolio: McKesson ClaimsXten™ 6.0 and ClaimsXten Select™ 2.0. Designed for payers navigating the transition to value-based models, both ClaimsXten solutions streamline payment and reimbursement policy management to help reduce the cost and complexity of scaling mixed fee-for-service and value-based models. Read the press release

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Weighing The Financial Impact Of MIPS Vs. APM

Weighing the Financial Impact of MIPS vs. APM

  • January 18, 2016

Columnist Ed Rabinowitz needed to sort out the financial implications of Merit-Based Incentive Payment System (MIPS), and alternative payment models (APM) for Physician’s Money Digest. He sat down with McKesson’s Dr. Andrei Gonzales who shared some pros and cons of both payment models and offers some practical insights for physician practices who will soon face this decision. Read the article

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25 Things To Know In Revenue Cycle Management

25 Things to Know in Revenue Cycle Management

  • December 22, 2015

A must-read for revenue cycle management leaders: Becker’s Hospital CFO serves up 25 things to keep on your radar. Number 4 on the list was RelayHealth Financial associate vice president  Carmen Sessoms’ key indicators to watch while transitioning to a new EMR/EHR system. The article was also published in Becker's Revenue Cycle Management Report. Read the article

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