Evidence-Based Care Guidelines will be used to Combat Waste in Medicare Programs
SEATTLE, March 3 /PRNewswire/ -- HealthDataInsights, Inc. (HDI), 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(R). HDI will use the Care Guidelines content and software to review Medicare claims.
HDI is the RAC for 17 Western states -- Montana, Wyoming, North Dakota, South Dakota, Utah, Arizona, Alaska, California, Hawaii, Idaho, Iowa, Kansas, Missouri, Nebraska, Nevada, Oregon and Washington. CMS has announced that the RAC Program rollout will be nationwide by January 1, 2010. Under federal law, RACs review claims for compliance with CMS reimbursement policies, and identify both underpayments and overpayments.
HDI will use 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 any specific guidelines or criteria for utilization reviews.
"This breadth and detail of the Care Guidelines enable informed and consistent clinical decisions for the best possible care management 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 also enables quality and audit organizations to effectively manage their review processes and initiatives to improve medical care delivery."
The Care Guidelines promote healthcare quality by providing clinical guidelines based on the best available clinical evidence. The Care Guidelines also incorporate detailed quality measures from the Hospital Quality Alliance (CMS Core Measures) and other national standards-setting groups. Each guideline topic outlines key issues, and provides details on clinical interventions to improve patient outcomes.
HealthDataInsights, headquartered in Las Vegas, uses proprietary software and conducts medical reviews to analyze clients' healthcare claims to identify and recoup improper payments. The company's experienced management team has previously worked together to build major healthcare companies, including dialysis and infusion therapy services. The company has operations in Fountain Valley, Calif., and Orlando, Fla. For more information, visit www.healthdatainsights.com.
About Milliman Care Guidelines
Milliman Care Guidelines LLC, A Milliman Company, is located in Seattle, and independently develops and produces evidence-based clinical guidelines and a variety of software options that are used by more than 1,000 clients nationally and support the care of almost two-thirds of US health plan members. Covering the continuum of care, the seven-product Care Guidelines series is updated annually by an experienced team of clinicians. For more information, visit www.careguidelines.com.
Milliman Care Guidelines is a wholly owned subsidiary of Milliman, Inc., which is among the world's largest independent actuarial and consulting firms. Founded in Seattle in 1947 as Milliman & Robertson, the company now has 49 offices in key locations worldwide. Milliman employs more than 2,000 people, with a professional staff of more than 1,000 qualified consultants and actuaries, including specialists ranging from clinicians to economists. The firm has consulting practices in healthcare, employee benefits, property and casualty insurance, life insurance, and financial services. Milliman serves the full spectrum of business, financial, government, union, education and nonprofit organizations. For more information, visit www.milliman.com.
|SOURCE Milliman Care Guidelines|
Copyright©2009 PR Newswire.
All rights reserved