Connolly will use InterQual, the gold standard in evidence-based clinical guidelines, as a tool in reviewing the medical necessity portion of RAC audits in the 15 states and territories it was awarded by CMS. In addition, Connolly will have the ability to review the full spectrum of InterQual Criteria along with historical content, through a McKesson-hosted solution that safeguards patient-identifying information.
The CMS RAC program is being rolled out to all 50 states by 2010 and authorizes CMS to correct any ‘improper payments’, including overpayments of past services for Medicare patients paid after October 1, 2007.
Connolly is licensing McKesson’s full InterQual line of care management products, including Level of Care, Care Planning with the new Molecular Diagnostics Criteria, and Behavioral Health Criteria. Connolly and its subcontractor, Viant will also have access to historical criteria dating back to 2004, allowing auditors to view specific criteria in effect when services were delivered and conduct utilization reviews based on that past criteria, leading to greater efficiencies and savings.
Tammie Phillips, vice president of InterQual for McKesson, said: “We’re thrilled Connolly selected InterQual for their RAC work in their CMS awarded service area as our products have such a large presence in many of these states. Utilizing InterQual will help to make the RAC auditing a smoother process for everyone involved.”