NEWTON, Mass., September 29, 2011 — McKesson today announced that, for the 12th consecutive year, the Centers for Medicare & Medicaid Services (CMS) will be using McKesson’s InterQual Criteria, a leading evidence-based clinical decision support criteria, for its Medicare inpatient services auditing programs. By extending its use of InterQual content for decision management, CMS will foster alignment between payers and providers in this era of health reform. 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. The criteria will also be used by departments within CMS as well as by Administrative Law Judges to assist with appeals decisions.
CMS entities will be using the InterQual 2011 release, which builds on the acute care content by adding new condition-specific criteria subsets that are designed to simplify the review process and enable more proactive patient-specific care decisions. This new offering aggregates criteria for all levels of care in one place, combines severity and intensity criteria for admission and continued stay review, and incorporates a unique “response to treatment” assessment, while considering a patient’s morbidities, complications and safety issues. Together these enhancements help to decrease inappropriate admissions, unnecessary readmissions and avoidable days.
“We are thrilled that CMS has selected our InterQual Criteria for the twelfth consecutive year to support its Medicare initiatives, especially as we transition to this era of health reform,” said Matthew Zubiller, vice president of decision management for McKesson Health Solutions. “In renewing this contract, CMS has once again acknowledged the ongoing value of the InterQual criteria to the industry and its auditing programs as a trusted source of reliable evidence-based content across a range of care settings. We hope to continue to support organizations striving to meet reform requirements with criteria that create a common language across stakeholders and promote payer and provider alignment.”
The InterQual Criteria will be delivered to CMS and its contractors 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.
