Sneak peek: Milliman or InterQual: Which product is right for your facility?
Case Management Weekly, January 27, 2010
Want to receive articles like this one in your inbox? Subscribe to Case Management Weekly!
It’s very likely that at one time or another, every person is asked one of the following questions: Coke® or Pepsi? Burger King® or McDonald’s™? The Beatles or The Rolling Stones? In the case management world, there is a similar question about brand allegiance: InterQual or Milliman?
Care guidelines are essential for ensuring the medical necessity of inpatient stays, using resources appropriately, and appealing denials.
And hospitals are not the only ones. Government auditing agencies, government payers, and private payers also use care guidelines programs to determine whether they will pay a claim.
So the question remains: Which of the two major products is better?
The answer is about as clear as it would be for Coke or Pepsi. It’s more a matter of preference, and that preference can be based on several factors:
-
Which product was used to train staff members?
-
Which product do staff members find easier to navigate?
-
Which product does a specific payer use?
Want to receive articles like this one in your inbox? Subscribe to Case Management Weekly!
Related Products
Most Popular
- Articles
-
- HIPAA Q&A: Level of encryption needed for email
- Q&A: Acute respiratory failure diagnosis does not require intubation
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- HIPAA Q&A: TPO disclosures to a business associate
- Capturing all necessary codes for IUD insertion and removal can be challenging
- What does case-mix index mean to you?
- Topic: CMS, OESS post new security compliance review information, checklist
- Identify potential Medicaid RAC target areas
- Q/A: Coding infusions to correct low potassium levels
- OB services: Coding inside and outside of the package
- E-mailed
-
- HIPAA Q&A: Level of encryption needed for email
- Q&A: Acute respiratory failure diagnosis does not require intubation
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- Q/A: Coding infusions to correct low potassium levels
- CMS has reformulated payments for some bilateral procedures
- Oxygen Cylinder Storage Requirements
- Q&A: Follow CMS' coding guidelines when using modifier -25
- Hospitals are not bound by InterQual criteria for determining patient status
- Q/A: New code for image-guided minimally invasive lumbar decompression
- Understand the spine to code back procedures correctly
- Searched