With the purchase by UnitedHealthcare (UNC) of Change Healthcare, providers are contemplating notable differences between two sets of quidelines. Change Healthcare owns InterQual criteria, while UHC has traditionally used MCG criteria.
Becoming familiar with the variances in terms of observation timeframes, screening methodologies, severity of illness thresholds, and intensity of service thresholds for levels of care will be the topic reported on by Kelvin Valera, MD, a healthcare consultant and physician advisor, during the next edition of Monitor Mondays.
Other segments to be featured during the live broadcast include the following:
- Social Determinants of Health: Ellen Fink-Samnick,anationally recognized expert on the social determinants of health (SDoH), will report on the latest news that’s occurring at the intersection of healthcare and socioeconomics. Ellen will also conduct the Monitor Mondays Listeners Survey.
- Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.
- Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.
- RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.
- Court Report: Famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, will report that the pharmaceutical company Roche and Medicare Advantage insurer Humana have agreed to pay $12.5 million to the U.S. government to resolve allegations that the companies violated the anti-kickback statute – marking the first False Claims Act (FCA) settlement resulting from a pharmaceutical company’s alleged payment of kickbacks to a Medicare Advantage Organization.
