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 m
|SOURCE Milliman Care Guidelines|
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