Milliman criteria admission

• [DOCX File]Reading a Research Study

  https://info.5y1.org/milliman-criteria-admission_1_fd9138.html

  Transitioned the organization from the use of Interqual to Milliman criteria. Responsible for all Charge Master updates, maintenance, and compliance. Oversaw the functions of the revenue integrity including: charge capture, nurse auditing, resolution of all billing edits, weekly CBO conferences, and investigation of all irregularities.

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• [DOCX File]IN.gov | The Official Website of the State of Indiana

  https://info.5y1.org/milliman-criteria-admission_1_8809ac.html

  The Contractor must be NCQA UM or URAC Health UM accredited within one year of operation. The Contractor will be required to use Milliman Care Guidelines for clinical standards of care determination. The Contractor must provide two licenses for the State’s use to access Milliman Care Guidelines directly. 4.2 . Administrative Structure

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• [DOCX File]Title:

  https://info.5y1.org/milliman-criteria-admission_1_738fce.html

  Milliman criteria for admission, continued stay. Palliative care/pain service/hospice issues. Bedside Acute Care RNs reporting on patients are prepared with the following information: Patient diagnosis and brief medical updates. Patient’s progression through continuum of care.

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• [DOC File]East Tennessee State University

  https://info.5y1.org/milliman-criteria-admission_1_da86ca.html

  Clinical review on every admission/observation using Interqual and Milliman Criteria. Conducted Core Measure reviews on all patients with Pneumonia, Congestive Heart Failure, and Acute Myocardial Infarction. Queried physician to ensure compliance with Core Measure Criteria.

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• [DOCX File]Finding Your Lost Inpatients

  https://info.5y1.org/milliman-criteria-admission_1_550ab6.html

  Medicare is concerned about the criteria for inpatient admission; you should be too ... She says not to worry so much about InterQual criteria or Milliman’s care guidelines, neither of which does Medicare endorse. Instead, “just document the patient’s story in a way your mother would understand. Just tell why the person needs to be in the ...

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• [DOC File]DONNA MANDRELL, LVN

  https://info.5y1.org/milliman-criteria-admission_1_b73a16.html

  Identify Estimated Length of Stay and necessity using Apollo, Interqual and/or Milliman Healthcare Guidelines. Ensure approval/denial of admission within 24-hours of notification. Coordinate and ensure timely discharge planning with appropriate ancillary providers. Identify Potential CCS Eligible conditions and coordinate with CCS Coordinator.

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• [DOC File]www.aaciweb.com

  https://info.5y1.org/milliman-criteria-admission_1_cfe8d5.html

  Hospitals should be directed to acquiesce to the decision of the attending physician regardless of other inpatient admission requirements. Hospitals tend, generally, to use InterQual and Milliman standards that may or may not be consistent with and/or accepted in lieu of the over two-midnight criterion as enunciated by CMS.

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• [DOC File]Specialty Appeal Letters

  https://info.5y1.org/milliman-criteria-admission_1_86c9bc.html

  The following interview between the Kansas Department of Insurance and a hospital negotiator discusses one hospital's successful efforts to specify that their MCO contract use Interqual instead of Milliman & Robertson due to the fact the Milliman & Robertson is based on "optimal efficiencies" which some rural hospitals cannot reach: www ...

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• [DOC File]Guidelines for Admission to the CDU

  https://info.5y1.org/milliman-criteria-admission_1_e468d2.html

  Note: If at the time of admission it is anticipated that the patient’s hospitalization will exceed 24 hours, a short stay admission shall be deferred in favor of routine hospital admission. The ED attending shall review the patient’s stay in the CDU if in excess of 24 hours and the …

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• The Chambersburg Hospital

  Strong computer skills and working knowledge of admission and discharge criteria such as Interqual and Milliman are required, along with a solid foundation in MS-DRG, APR, DRG, AP-DRG systems and ICD-9-CM. Physician Advisor Page 1 of 4

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