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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How To Engage Providers Differently To Satisfy The New Healthcare Consumer

How to Engage Providers Differently to Satisfy the New Healthcare Consumer

  • December 22, 2015

In a recent article for Morning Consult, Dianne Wagner of Florida Blue and our own Carolyn Wukitch, McKesson Health Solutions shared their insights on building provider engagement. “To help consumers have a positive experience with their health plans, we recommend designing custom networks for targeted populations. Give consumers the current and accurate information they need to choose a plan and providers within the network,” the executives wrote. The advice includes how health plans can use key trends to their advantage. Read the full article

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McKesson Extends Contract With EQHealth

McKesson extends contract with eQHealth

  • December 7, 2015

Radiology and diagnostic imaging news site AuntMinnie.com covered our recent customer news. We announced that eQHealth will use InterQual evidence-based clinical criteria for its state Medicaid contracts in Florida, Illinois, Mississippi, and Colorado, in addition to its other commercial lines. Read the full story

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Quality Health Associates Of North Dakota Chooses InterQual For State Medicaid Reviews

Quality Health Associates of North Dakota Chooses InterQual for State Medicaid Reviews

  • October 5, 2015

Today we announced that Quality Health Associates of North Dakota has signed its first long-term agreement to use InterQual for all Medicaid utilization and quality reviews in North Dakota. They licensed all of the InterQual Level of Care Criteria and Behavioral Health Criteria,; as well as InterQual Procedures, Imaging, Durable Medical Equipment (DME); and Molecular Diagnostics Care Planning Criteria. Read the news release

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