InterQual Criteria for Inpatient Admission

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InterQual Criteria for Inpatient Admission

assigning appropriate admission status – Saint Vincent Health System
Jan 11, 2013 … Inpatient status. • Admission criteria: Interqual/ Milliman. • Considered by CMS to be a tool. • “The decision to admit a patient is a complex.

Mistaken Admission: Establishing Medical Necessity for Inpatient …
page 8 for information about InterQual® criteria.) Medicare classifies as an inpatient anyone who is formally admitted to a hospital with the expectation that he or …

COMP-RCC 4.19 INTERQUAL Accuracy Audit – Tenet Healthcare …
Feb 7, 2013 … provides criteria for inpatient admission level of care. B. “INTERQUAL user” means the individual performing the initial INTERQUAL inpatient …

In the Case of Triumph Hospital Detroit – U.S. Department of Health …
relevant InterQual criteria for inpatient admissions for cellulitis and/or uncontrolled pain. The appellant filed a request for review with the Council on. July 30 …

GUIDELINES Medicare Decisions: Observation or Inpatient?
Can Observation Admission be changed to Inpatient Admission? YES! … InterQual Criteria are used by HSAG/CMS to determine the appropriate level of care.
InterQual® Criteria Overview 2009 – Banner Health
Observation, Acute Inpatient and Swing Bed/Sub. Acute admissions. ➢ Regardless of the patient\’s admission status, they must still meet the appropriate criteria …
Adopting the Same Admission Criteria as RACs Is Expensive and …
ministrative contractor (MAC) uses InterQual, the qual- … and the RAC plans to apply both sets of criteria. … inpatient admission screening criteria as its RAC to.
Guidance on Hospital Inpatient Admission Decisions
information about Sole Community Hospital (SCH) classification criteria and … include Interqual, Milliman, and other proprietary systems. CMS Policy Guidance. To assist hospitals regarding inpatient admission decisions, CMS would refer.
Molina Inpatient Review Policy – Molina Healthcare
Nov 1, 2010 … following will occur when a facility requests an inpatient admission: 1) If Inpatient InterQual® Admission Criteria is not met and InterQual® …
2.20 INPATIENT SERVICES 2.201 Acute Inpatient … – ValueOptions
Acute inpatient mental health treatment represents the most intensive level of … Criteria. Admission Criteria. The following criterion is necessary for admission: 1.
Health Care Compliance Association Inpatient Short Stay …
observation status as well as a greater focus on InterQual (or other inpatient screening criteria) guidelines for inpatient admission. It is essential that hospitals  …
The RAC Sheet – New York Health Law Attorney
Apr 1, 2011 … CMS Refines Guidance Regarding Inpatient Admissions. Previously during the … the Interqual and Milliman criteria). While acknowledging that …
Blue Essentials Prior Authorization List.pdf
Inpatient Facility. Inpatient admissions to Long Term Care Hospitals. Inpatient admissions to Rehabilitation Hospitals. *McKesson Interqual Criteria utilized.
Reducing Medically Inappropriate Admissions – Medicare Patient …
InterQual criteria are designed to assist nonphysician reviewers and can be used …. The hospital has not submitted a claim to Medicare for inpatient admission.
Eating Disorders – 91007 – Priority Health
Sep 24, 2012 … psychiatric inpatient admissions (including criteria for severity of need and intensity … medical/surgical benefits and InterQual criteria will apply.
Medical Management – Tufts Health Plan
care, including inpatient admissions to hospitals, acute rehabilitation facilities, and skilled nursing … Acute inpatient hospitalization, utilizing InterQual® criteria.
professional services provider manual – Louisiana Medicaid
appropriateness of inpatient admissions and continued inpatient stays. InterQual criteria clinical content is a synthesis of evidence-based standards of care, …
Click here to download the list – HCPro Blogs
If Outpatient Observation, was the patient later admitted to inpatient level of care? ❒ YES ❒ NO. Criterion for Assessment of Admission (InterQual 2010).
Provider Manual – Section 6.0 – Passport Health Plan
through Friday, between the hours of 8 a.m. and 5:30 p.m.. 6.5.1 Inpatient Status. UM reviews all requests for inpatient admissions utilizing InterQual® Criteria.
Medicare Plus Blue PPO non-Michigan acute inpatient fax …
Inpatient Fax Assessment Form. InterQual criteria MET. InterQual criteria Not MET … of this member receiving a human organ transplant during this admission?


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AARP health insurance plans (PDF download)

AARP life insurance (PDF download)

medicare benefits (PDF download)

medicare coverage (PDF download)

medicare part d (PDF download)

medicare part b (PDF download)

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