Evidence-Based Care Guidelines will be used to Combat Waste in Medicare Programs
SEATTLE, June 4 /PRNewswire/ -- Connolly Healthcare, a permanent Recovery Audit Contractor (RAC) for the Centers for Medicare & Medicaid Services (CMS), has signed a five-year license agreement with Milliman Care Guidelines.
Connolly will use the Care Guidelines content and software to review Medicare claims in 15 states -- West Virginia, Virginia, North Carolina, South Carolina, Georgia, Florida, Alabama, Mississippi, Louisiana, Tennessee, Arkansas, Texas, Oklahoma, New Mexico, Colorado -- plus the territories of Puerto Rico and the US Virgin Islands. Under federal law, RACs review claims for compliance with CMS reimbursement policies, and identify both underpayments and overpayments. According to CMS, the RAC Program will rollout nationwide by January 1, 2010.
Connolly will use all of the annually updated, evidence-based Care Guidelines products -- Ambulatory Care, Inpatient and Surgical Care, General Recovery Guidelines, Recovery Facility Care, Home Care, Chronic Care Guidelines, and Behavioral Health Guidelines. CMS does not mandate or endorse the use of any specific screening product for medical reviews.
"The breadth and detail of the Care Guidelines enable informed and consistent clinical decisions for the best possible care throughout the entire care continuum," said Scott Harris, Milliman Care Guidelines Senior Vice President of Sales and Marketing. "Having access to our evidence-based clinical tools enables quality and audit organizations to effectively manage their review processes and initiatives to improve the care provided for Medicare beneficiaries."
The Care Guidelines promote healthcare quality by providing clinical guidelines based on the best available clinical evidence. The Care Guide
|SOURCE Milliman Care Guidelines|
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