OREANDA-NEWS. March 13, 2013. The Centers for Medicare & Medicaid Services (CMS) is using McKesson’s InterQual® Criteria for its Medicare services auditing programs. Through its use of InterQual, CMS can access the entire spectrum of InterQual Criteria products to support quality oversight, utilization review and appeals decisions. 

Quality Improvement Organizations (QIOs), Medicare Fiscal Intermediaries, Medicare Administrative Contractors (MACs), Administrative Law Judges and various CMS departments are now using the InterQual 2012 release. A key enhancement for 2012 includes the extension of a “condition-specific” model to the full InterQual Acute Care suite, driving the further efficiency and effectiveness of care management processes. This model organizes the criteria by primary condition, then integrates a wealth of additional information designed to address relevant complications, co-morbidities and guidelines for standard treatments.

“McKesson is understandably proud of our continued relationship with CMS, which supports optimal decision-making for Medicare beneficiaries,” said Matthew Zubiller, vice president of Decision Management for McKesson Health Solutions. “InterQual is a critical component in the care management programs of more than 5,000 payers, providers and government agencies, forming a common language for evidence-based discussions of medical appropriateness. As the industry moves steadily toward a more collaborative system built around improving the quality and cost of healthcare, CMS continues to recognize the importance of choosing the right solutions to support that collaboration.”

Buccaneer, a part of General Dynamics Information Technology, administers the contract on behalf of CMS. The InterQual Criteria is delivered to CMS and its contractors via InterQual® Online Anonymous Review, a McKesson-hosted solution that allows users to input and save reviews without exposing patient-identifying information. Users also can review historical criteria through the hosted solution, facilitating date-sensitive reviews for programs that look at medical necessity information retrospectively.

For more information on McKesson Health Solutions, please visit our Web site, hear from our experts at MHSdialogue, join our community on LinkedIn and follow us on Twitter at @McKesson_MHS.