Health Care Financing Administration to Use InterQual Utilization Management Criteria.Business Editors, Health/Medical Writers ATLANTA--(BUSINESS WIRE)--Jan. 6, 2000 McKesson HBOC HBOC HBO & Co of Georgia HBOC Hereditary Breast and Ovarian Cancer HBOC Hemoglobin-Based Oxygen Carrier HBOC Hawke's Bay Orienteering Club (New Zealand) HBOC Hunter Bird Observers Club HBOC Horse Breeders and Owners Conference , Inc. (McKessonHBOC) (NYSE NYSE See: New York Stock Exchange :MCK MCK McKinsey & Company (consulting firm) MCK Mohawk Council of Kahnawake (Quebec) MCK Mon Colle Knights (children's TV show) MCK Mirror Classes Kit MCK Maintenance Check ) today announced that the Iowa Foundation for Medical Care Iowa Foundation for Medical Care (IFMC) is a non-profit organization which provides services in health care quality improvement and medical information management. IFMC is based in West Des Moines, Iowa and has offices in Illinois, Maryland, Nevada and Virginia. (IFMC IFMC Iowa Foundation for Medical Care IFMC International Festival of Modern Choreography (Vitebsk, Belarus) ), on behalf of the Health Care Financing Administration Health Care Financing Administration, n.pr department in the U.S. agency of Health and Human Services responsible for the oversight of the Medicaid and Medicare benefit programs, including guidelines, payment, and coverage policies. (HCFA HCFA abbr. Health Care Financing Administration HCFA, n.pr See Health Care Financing Administration. ), has awarded a contract to the McKessonHBOC InterQual(R) Products Group to supply its clinical appropriateness criteria for use in reviewing Medicare hospital inpatient services. An audit of HCFA's 1996 and 1997 financial statements estimated that Medicare made more than $20 billion in incorrect payments each year. Of those amounts, approximately 20 percent occurred in inpatient services under the Prospective Payment System and resulted primarily from providers billing for services that were incorrectly coded, not covered not covered Health care adjective Referring to a procedure, test or other health service to which a policy holder or insurance beneficiary is not entitled under the terms of the policy or payment system–eg, Medicare. Cf Covered. , insufficiently documented or medically unnecessary. After the audit, HCFA issued a mandate to its Utilization and Quality Control Peer Review Organizations (PROs) to initiate a payment error prevention program. Under the terms of the program, each PRO will send 1,100 randomly selected medical records from Medicare patients to one of the two Clinical Data Abstraction Centers (CDACs) created by HCFA. The CDACs will do a first level review of these records using the InterQual criteria in an effort to identify reasons for inappropriate admissions, miscoded diagnoses and other problems leading to payment errors. Any medical records that do not meet InterQual criteria will be sent back to the PROs for further review. According to Christopher Bishop, senior vice president and general manager of the McKessonHBOC InterQual Products Group, InterQual's standardized utilization management criteria will help the PROs review the procedures for their medical necessity. As a result, HCFA will be able to review its Medicare reimbursement policies, with a view toward eliminating unnecessary healthcare expenditures. Under the contract, HCFA will use the following InterQual products: -- ISD-AC A/P A/P Airport A/P Accounts Payable A/P Advanced Placement (education) A/P Anterior/Posterior A/P Active/Passive A/P Assessment & Plan (medical) A/P Automatic Pilot A/P Aircrew Personnel (R) -- Assesses the clinical appropriateness of the patient's admission to, continued stay and discharge from the acute-care setting. -- ISP (1) See in-system programmable. (2) (Internet Service Provider) An organization that provides access to the Internet. Connection to the user is provided via dial-up, ISDN, cable, DSL and T1/T3 lines. (R) -- Provides patient-specific clinical data to help determine the appropriateness of surgical intervention and/or procedures for a particular patient. HCFA will use the InterQual criteria in the product's computerized format using McKessonHBOC's Autobook 2(R) software. This will enable reviewers to aggregate data to identify patterns and possible causes that might have led to payment errors. "We are confident that our extensive experience in the development of utilization review u·til·i·za·tion review n. A process for monitoring the use, delivery, and cost-effectiveness of services, especially those provided by medical professionals. software will provide the PROs with a very useful tool to make major strides in HCFA's payment error prevention initiative," Bishop said. Steve Windbery, M.D., clinical director of the Tennessee PRO's payment error prevention program, commented: "InterQual criteria software is comprehensive software. It's the gold standard for evaluating the appropriateness of admissions." McKesson HBOC, Inc., a Fortune 60 corporation, is the world's largest pharmaceutical supply management and healthcare information technology company. McKessonHBOC provides pharmaceutical supply management and information technologies across the entire continuum of healthcare, including market-leading businesses in pharmaceutical and medical-surgical distribution, information technology for healthcare providers, services for payors and outsourcing. More information about McKessonHBOC is available on its World Wide Web site at http://www.mckhboc.com. McKessonHBOC's Information Technology Business solutions include enterprisewide patient care, clinical, financial and strategic management software solutions, as well as networking technologies, electronic commerce, outsourcing and other services to healthcare organizations throughout the world. The InterQual Products Group, a business unit of McKessonHBOC's Information Technology Business, is the worldwide leader in the development of utilization review criteria for the healthcare industry. Based in Marlborough, Mass., the InterQual Products Group develops and maintains a wide variety of clinical decision support criteria that help improve care and manage resources by screening for clinical appropriateness. InterQual criteria are used by more than 1,900 hospitals in the United States Lists of hospitals for each U.S. state:
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