CMS to Sustain their Long-term Use of InterQual Criteria

McKesson Health Solutions (MHS) declared today that the Centers for Medicare & Medicaid Services (CMS) will sustain their long-term use of InterQual®Criteria for Medicare services auditing programs, extending a seventeen year connection with McKesson Health Solutions. The agreement, which will be administered and managed by Baltimore-based Ventech Solutions Inc. on behalf of the Centers for Medicare and Medicaid Services, gives access across the spectrum of InterQual Criteria to assist support quality oversight, appeals decision and utilization review.

Medicare Administrative Contractors (MACs), Medicare Fiscal Intermediaries, Administrative Law Judges, Quality Improvement Organizations (QIOs), and several CMS departments can approach InterQual 2016 evidence-based clinical decision support to assist better manage care in an industry transitioning to value. InterQual Criteria is delivered to the Centers for Medicare and Medicaid Services (CMS) and its contractors via InterQual Anonymous Review, a hosted solution that lets consumers complete and save reviews without revealing PHI (personal protected health information).
Clinical decision-making and care management across the medical and behavioral health continuums of care are being improved by the assistance of InterQual evidence-based criteria and technology solutions. The InterQual clinical development group synthesizes the most current, great evidence into a completely referenced decision support tool. InterQual’s development procedure is discovered on rigorous analysis of the literature, and involves extensive peer observation or review by practicing clinical experts across the US.