Case Management

Quality Improvement Organization to use InterQual standards in first review of short-stay claims

Case Management Insider, October 13, 2015

In a September 30 webinar, KEPRO’s Cheryl Cook, the organization’s area two and four program director, said that the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) will conduct the initial review of short-stay claims under the 2-midnight rule using the familiar InterQual® standards.

This may be good news for case managers, many of whom already use these standards. Cook said short-stay claims that fail this initial InterQual review will move on to a second physician review to determine whether the claim is valid.

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to read a transcript of the webinar and check out a full analysis of the decision and some helpful compliance tips from our experts in the December issue of Case Management Monthly.

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