Every day, InterQual® Criteria is used to determine the medical necessity for the care of patients. Both payers and providers use the criteria in the same way to determine the appropriate level of care, and in turn, the appropriate care status. When reviewing patient care, we often find that the services provided at the Observation or Acute Level of Care are the same. So which level of care, or care status, is correct? The determining factor is always the clinical presentation of the patient.
In this session, we will use case studies to review the clinical presentation of different patients and demonstrate how the InterQual® Criteria can help both payers and providers determine the most appropriate level of care. We will also review the resources available to assist the reviewer in determining the length of stay and the percentage paid at the observation level of care for the patient’s condition. Our clinical consultants will answer as many of your questions as time allows during the session.
Thursday, March 18, 2:00 p.m. ET / 11:00 a.m. PT
Presenters:
Lisa Nuelle, RN, BSN, CCM, IQCI
Senior Clinical Education Consultant, Change Healthcare
April Collins, RN, BSN, ACM, IQCI
Senior Clinical Education Consultant, Change Healthcare