Interqual?

Specialties Case Management

Published

Just wondering what exactly this is. I think is has to do with determining acuity of care but would like to see what case managers in the industry define it as.

Thanks,

Ginger

Specializes in psychiatric, UR analyst, fraud, DME,MedB.
Ginger35 said:
Just wondering what exactly this is. I think is has to do with determining acuity of care but would like to see what case managers in the industry define it as.

Thanks,

Ginger

Interqual is used quite a lot....it is based from the severity of the illness ( SI) and intensity of the service (IS) . I find this better than some , like the Milliman & Robertson. there are yearly updates too , so your facility should have the most current. Not all hospitals use Interqual..... The funny thing about it though is that there are hospitals (in their case mgmt.) who claims to use the Interqual, and yet the case manager supervisor can not produce any book of Interqual when I asked for it! I have heard that it is expensive........but if they do not have the guideline, how can they follow it correctly? These are one of the reasons that I got out and will stay out from case managing, (hospital base)---they expect you to do somethng wonderful and yet they won't supply you w/ the right tools!!! It is a wonderful position if staff, doctors, & admitting personnel work adhesively and well. this is the key........

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New book that is used at our small Hsp. is small and affordable

Standard Hospital Admission Criteria (SHAC) $9.99

We use this when someone is admitted from the emergency room.

find it on web-site www.rapitube.com

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Specializes in ICU,ANTICOAG,ACUTE STROKE,EDU,RESEARCH.

Just looking at this thread because I had seen a Case management position available and it mentioned Interqual.

In this

I take Remicaid for my RA, and developed a severe Pyelo. I had >18,000 wbc, fever >105 (Mckesson rounds up 1 degree for core body temp), hematuria and pyuria, and I'm immunocompromised, and I still didn't get admitted, cuz I could still take po (barely), wasn't vomiting, and succeeded at OP tx

If so much relies on meeting all the criteria, and you were clearly unwell enough clinically (IMO and many others) , if you could barely take PO why do the staff not put up an IV to supplement your hydration which is bound to be inadequate when you are feeling so ill and would also speed up your recovery, especially considering your type of illness.

Now I am beginning to understand why readmission rates are so high. I am thinking you are fairly young, but if it had been someone who was 75 they could have gone home and died, or been admitted with full blown sepsis needing critical care

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Specializes in Provider Collector.

I am a new here, and wondering what exactly is InterQual and also, if I have a question regarding one of its "criteria's" not having been met, who can I address it with. Is there someone to call?

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Specializes in Case Managemnt, Utilization Review.

I an an Interqual Certified Instructor, you would need to ask your management team if you are able to call Change Health Care( formerly McKesson) in reference to your question or if there is a chain of command to follow before actually making the call to them directly. It is my understanding that facilities have a fee for calls that are made to Change Health Care. Make sure to read the little information notes , they are very helpful . Read the front page ( on the computer) for the subset you pick. There is no bending of the clinical information. You either have the information or you do not. You can not read into the clinical information provided.

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Specializes in case management.

Is there any training outside of on the job training. Would like to do some on my own

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