Case Management

Sneak peek: Milliman or InterQual: Which product is right for your facility?

Case Management Weekly, January 27, 2010

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.

Although care guidelines products such as Milliman and InterQual are no substitute for a physician’s professional opinion, hospitals nationwide use them every day.

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?
Check out the February 2010 issue of Case Management Monthly to learn more. You also can discover the benefits of becoming a Case Management Monthly subscriber.

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