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Two More Recovery Audit Contractors Select McKesson's InterQual Clinical GuidelinesNovember 10, 2010 |
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Diversified Collection Services and HealthDataInsights Join Connolly Healthcare in Using Clinical Guidelines for CMS RAC Services McKesson recently signed long-term agreements with two regional Recovery Audit Contractors (RACs) for the Centers for Medicare & Medicaid Services (CMS) for the use of McKesson’s InterQual ® Criteria. Diversified Collection Services, Inc and HealthDataInsights, Inc. along with Connolly Healthcare, a RAC that signed a similar agreement earlier this year, will use InterQual evidence-based clinical guidelines as a tool in reviewing the medical necessity portion of RAC audits across 43 states. The RACs will have the ability to review the full spectrum of market-leading criteria through a McKesson-hosted solution that safeguards patient-identifying information. The CMS RAC program authorizes CMS to correct any “improper payments,” including overpayments of past services for Medicare patients paid after October 1, 2007. Hospitals are required to provide clinical documentation in support of the medical necessity of care rendered. CMS does not mandate or endorse any specific screening criteria for the reviews of medical necessity services. The RACs are licensing McKesson’s full InterQual line of clinical decision support products, including Level of Care , Molecular Diagnostics and Behavioral Health criteria. The RACs will have access to historical criteria dating back to 2004, allowing auditors to view and conduct utilization reviews based on criteria in effect when services were delivered. “We are excited to see the power of our InterQual Criteria being used to increase RAC auditing efficiency across the country,” said Rose Higgins, vice president of care management solutions for McKesson Health Solutions. “The national use of InterQual continues to broaden, creating a common ground for clinical decision-making between payors and providers. In addition to signing the three RACs, the majority of Medicare Administrative Contractors and QIOs have contracts to use InterQual, and we look forward to continuing to develop agreements with other government organizations.” About the Recovery Audit Contractors Region A, awarded to Diversified Collection Services, Inc., covers Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island, New York, New Jersey, Pennsylvania, Delaware and Maryland. Region B, awarded to CGI Federal Inc., covers Minnesota, Wisconsin, Michigan, Illinois, Indiana, Kentucky and Ohio. Region C, awarded to Connolly Healthcare, covers Colorado, New Mexico, Texas, Oklahoma, Arkansas, Louisiana, Tennessee, Mississippi, Alabama, Georgia, Florida, South Carolina, North Carolina, Virginia and West Virginia. Region D, awarded to HealthDataInsights, Inc., covers Iowa, Missouri, North Dakota, South Dakota, Nebraska, Kansas, Montana, Wyoming, Idaho, Utah, Arizona, California, Nevada, Oregon, Washington, Alaska and Hawaii. 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 http://www.mckesson.com .
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McKesson Health Solutions
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