The Centers for Medicare & Medicaid Services (CMS) is using McKesson’s InterQual^® Criteria for its Medicare services auditing programs. Through its use of InterQual, CMS can access the entire spectrum of InterQual Criteria products to support quality oversight, utilization review and appeals decisions.

Quality Improvement Organizations (QIOs), Medicare Fiscal Intermediaries, Medicare Administrative Contractors (MACs), Administrative Law Judges and various CMS departments are now using the InterQual 2012 release. A key enhancement for 2012 includes the extension of a “condition-specific” model to the full InterQual Acute Care suite, driving the further efficiency and effectiveness of care management processes. This model organizes the criteria by primary condition, then integrates a wealth of additional information designed to address relevant complications, co-morbidities and guidelines for standard treatments.

“McKesson is understandably proud of our continued relationship with CMS, which supports optimal decision-making for Medicare beneficiaries,” said Matthew Zubiller, vice president of Decision Management for McKesson Health Solutions. “InterQual is a critical component in the care management programs of more than 5,000 payers, providers and government agencies, forming a common language for evidence-based discussions of medical appropriateness. As the industry moves steadily toward a more collaborative system built around improving the quality and cost of healthcare, CMS continues to recognize the importance of choosing the right solutions to support that collaboration.”

Buccaneer, a General Dynamics Company, administers the contract on behalf of CMS. The InterQual Criteria is delivered to CMS and its contractors via InterQual^® Online Anonymous Review, a McKesson-hosted solution that allows users to input and save reviews without exposing patient-identifying information. Users also can review historical criteria through the hosted solution, facilitating date-sensitive reviews for programs that look at medical necessity information retrospectively.

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About Buccaneer

Buccaneer is an information technology company owned by General Dynamics. It offers complete computer systems and analytical solutions to both government and corporate clients. The company is headquartered in Warrenton, Virginia, with branch offices in Baltimore, Maryland and Falls Church, Virginia, as well as West Des Moines, Iowa; Little Rock, Arkansas; and Sierra Vista, Arizona.

About McKesson Corporation

McKesson Corporation, currently ranked 14th on the Fortune 500, is a healthcare services and information technology company dedicated to making the business of healthcare run better. We partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. McKesson helps its customers improve their financial, operational, and clinical performance with solutions that include pharmaceutical and medical-surgical supply management, healthcare information technology, and business and clinical services. For more information, visit us at www.mckesson.com.

Tags: McKesson, McKesson Health Solutions, Medicare, CMS, InterQual, decision management, utilization review, evidence-based medicine, healthcare quality improvement