Interqual

prior clinical nursing work experience, formal training, and lots of real world application with critique (i.e. work experience where a good ur nurse provides feedback on your work). this is how i am picking it up easily. gl!

MBarnbsn,

thank you for your response

Linda,

There certainly are reasons not to like Interqual, especially if you are using the CERME software, identifying SI and IS is pretty straight forward and gets easier with experience. Using this criteria strictly is nonsense (to premise that a patient is not acute based on an artificial intensity of service is nuts) but I am sure there are supervisors who don't think so. I mean it really boils down to one question: Can this patient be treated at a lower level of care or not? Whether you are reviewing for a provider or a payor that is case you have to make.

hello d'cm

i agree i have had some patients come in who were train

wrecks and often why they were released from the hospital

now i am putting the big picture of interqual together.....you are

right can the patient be treated at a lower level of care. i guess

i will continue to practice and work with interqual and then i will

really catch on....do you know where i can purchase an interqual book?

linda

Hi, I believe my facility purchased a license to use interqual...with this license came training and the interqual books...if your institution is willing to pay more, there is also a software program where in which you enter clinical info and you will be told if the pt meets interqual or not...Not all insurance companies use interqual, some use milliman and roberts or other criteria. If we can't get a pt to meet interqual our protocol for medicare pt's is to call a company called Executive Health Resources. EHR reviews pt comorbidities, age, etc and helps us put the pt in "the right bucket" (IN vs Obs) and they will stand behind their determination. This has helped us with the RAC's. Interqual is SUPPOSED to be a guideline even though some insurance companies use it as their bible as they do not want to pay!