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CMS Extends Decade-Long Use of McKesson's InterQual Criteria to Support Medicare InitiativesAugust 10, 2010 |
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Quality Enhancements to Evidence-Based Criteria Will Better Support Medicare Contractors For the eleventh consecutive year, the Centers for Medicare & Medicaid Services (CMS) will be using McKesson’s InterQual ® Criteria , the industry’s leading evidence-based clinical decision support, for its Medicare inpatient services auditing programs. The agreement is being administered by Buccaneer Computer Systems & Service, Inc. on behalf of CMS. Through the agreement, Quality Improvement Organizations (QIOs), Medicare Fiscal Intermediaries, and Medicare Administrative Contractors (MACs) have access to the entire spectrum of InterQual Criteria products plus historical criteria to support their utilization review and quality oversight functions. This year, the criteria will also be offered to other departments within CMS as well as to Administrative Law Judges to assist with appeals decisions. CMS recently shifted responsibilities for measuring and preventing improper payments to hospitals from QIOs to MACs, enabling QIOs to better focus on improving patient quality of care and provider assistance efforts. InterQual 2010 features quality enhancements that will help support QIOs as they audit clinical decisions about levels of care. New Quality Indicator Checklists, focused on conditions for which the National Quality Forum has developed inpatient quality measures, will benefit QIOs as a convenient reference on certain quality standards. New Transition Plan Guidelines, which support comprehensive discharge planning for patients identified to be at high risk for readmission, will help QIOs with their goal of improving transitions of care. “We are excited that CMS once again selected our InterQual Criteria to support its Medicare initiatives,” said Rose Higgins, vice president of care management solutions for McKesson Health Solutions. “By renewing this contract, CMS is acknowledging the value of InterQual to its auditing programs as a source of reliable EBM content across a complete range of care settings.” The InterQual Criteria will be delivered via InterQual ® Online Anonymous Review, a McKesson-hosted solution that allows users to save reviews without exposing patient-identifying information. Users will also be able to use the hosted solution to review historical criteria, facilitating date-sensitive reviews for programs that look at medical necessity information retrospectively. About the Centers for Medicare & Medicaid Services Formerly known as the Health Care Financing Administration (HCFA), CMS is the federal agency responsible for administering Medicare, Medicaid, State Children’s Health Insurance, Health Insurance Portability and Accountability Act, Clinical Laboratory Improvement Amendments and several other health-related programs. Additional information regarding CMS and its programs is available at http://www.cms.gov/home/aboutcms.asp . About Buccaneer Buccaneer is a rapidly growing information technology firm offering complete computer systems and analytical solutions to both government and corporate clients. The company is headquartered in Warrenton, Virginia, with branch offices in Baltimore, Maryland and Falls Church, Virginia, as well as West Des Moines, Iowa; Little Rock, Arkansas; and Sierra Vista, Arizona. Buccaneer is certified as an 8(a) firm within the U.S. Small Business Administration’s Business Development Program. To learn more about Buccaneer, visit www.bcssi.com or e-mail information@bcssi.com . About McKesson McKesson Corporation, currently ranked 14th on the FORTUNE 500, is a healthcare services and information technology company dedicated to helping its customers deliver high-quality healthcare by reducing costs, streamlining processes, and improving the quality and safety of patient care. Over the course of its 177-year history, McKesson has grown by providing pharmaceutical and medical-surgical supply management across the spectrum of care; healthcare information technology for hospitals, physicians, homecare and payors; hospital and retail pharmacy automation; and services for manufacturers and payors designed to improve outcomes for patients. For more information, visit www.mckesson.com .
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