The Centers for Medicare & Medicaid Services (CMS) will be using McKesson’s InterQual Criteria, an evidence-based clinical decision support (CDS) criteria, for its Medicare inpatient services auditing programs.
The agreement is being administered by Buccaneer Computer Systems & Services, on behalf of CMS.
Through the agreement, quality improvement organizations, Medicare fiscal intermediaries, and Medicare administrative contractors can access InterQual Criteria, as well as historical criteria to support their utilization review and quality oversight functions. The criteria also will be used by departments within CMS and administrative law judges to assist with appeals.
CMS entities will be using a 2011 InerQual release, which builds on acute care content by adding new condition-specific criteria subsets for the review process and patient-specific care decisions.