Web Results



Industry Content by InterQual® | Change Healthcare ***** ... of Medicare National and Local Coverage Determinations (NCDs and LCDs) for Medicare patients undergoing inpatient or outpatient surgical procedures.

https://www.changehealthcare.com/.../interqual/industry-content-by-interqual

Change Healthcare COVID-19 Updates & Resources >> Industry Content by InterQual®  Content from the Centers for Medicare and Medicaid Services (CMS) and others is converted into our easy-to-use Q&A format to support consistent application of third-party content and improve review workflow and efficiency. Support Consistent Application of Third-Party Content to Improve Review Workflow and Efficiency Content from third-party sources is converted into our easy-to-use Q&A format. Policies that exist in disparate sources or are cumbersome to navigate are streamlined and structured using InterQual’s clinical rules and criteria development expertise. Content powered by InterQual can be incorporated seamlessly into your existing InterQual workflow to create a structured, interactive tool that can help reduce review times, support review consistency, and streamline the prior authorization process. Providing a single source for content helps minimize the need to use and update multiple systems and supports the consistent and efficient application of medical policies. Industry Content by InterQual are available for: Medicare Procedures -- Converts hundreds of Medicare National and Local Coverage Determinations (NCDs and LCDs) for Medicare patients undergoing inpatient or outpatient surgical procedures. Third party content --InterQual works with a variety of organizations to convert their proprietary content into our structured, actionable format.  Talk to Sales 1-877-292-0350   Interqual Support 1-800-274-8374




Inpatient only procedures — ACDIS Forums ***** The reason why many feel this is a UR issue is many screening tools, like Interqual, have an "inpatient" only list. UR typically verifies the ...

https://forums.acdis.org/discussion/3738/inpatient-only-procedures

eNewsletter SignupStoreContact Us ACDIS FORUMSFORUMS & TALK GROUP My director has asked me to think outside of the box and look into if CDI can help at all with catching the occasional inpatient only procedure that gets done as an outpatient.  I'm obviously not much on out of the box thinking today because I have no idea how CDI could have any impact on this topic.  Anyone out there have any ideas? Prairie Lakes Healthcare System Our program does not review OBS until/if they convert to inpatient.  I'm reluctant to even give much input on this question anyway as we have a utilization review department and I feel this is their area of expertise and not something that CDI should be responsible for.  I agree with you and am not sure why you would be asked if you have a UR program. They should be reviewing these OBS patients and assessing patient placement. If you are not reviewing OBS, there really is no way for you to have impact as part of your regular work flow. And it seems superfluous to ask you to review if you already have a UR team performing this task. We do loosely look for patients in IP that shouldn't be. Its not really 'our responsibility' but we do send cases to UR if they are in IP status and we are concerned that they may not meet criteria. But we have no involvement in what you are describing as we also do not review OBS cases. One of the ways to "catch" a possible inpatient only procedure that is scheduled as outpatient is to have someone review the surgery schedule for the next day.  They could look for any procedures that are on the inpatient only list.  I would suggest that task be assigned to someone in the UR Dept.  You could also provide education to the schedulers on the inpatient only list to try and catch these cases on the front end.  I would also involve the PACU staff and educate them to call UR/Case Management if a patient who is there for an outpatient procedure has anything else done during the surgery (a lap chole that has a repair of the bowel done during the procedure, etc.).  Again, this should be done by the UR/Case Management staff. 




Prior authorization ***** We review certain outpatient services and inpatient services to determine if they are ... We recommend using InterQual®' SmartSheets™ to submit requests for certain procedures. ... Prior authorization is required for surgical services only.

https://provider.bluecrossma.com/ProviderHome/.../precert_preauth.pdf?...

We review certain outpatient services and inpatient services to determine if they
are ... We recommend using InterQual®' SmartSheets™ to submit requests for
certain procedures. ... Prior authorization is required for surgical services only.




Premera Local Rules *****

https://secure.healthx.com/v3app/a/?...

In applying InterQual® 2018 criteria to different benefit packages, Premera ... The
procedure must be on the InterQual inpatient surgery list or be noted in the ...




Ads