The McKesson Corporation has secured deals with three of the four federally-approved Recovery Audit Contractors and will be providing medical necessity analytics tools for Medicare's auditing efforts in 43 states.
The San Francisco-based healthcare IT vendor announced Wednesday that is has signed long-term agreements with Diversified Collection Services, Inc., and HealthDataInsights, Inc. Earlier this year, the company signed a deal with Connolly Healthcare. All three will be using McKesson's InterQual Criteria, an evidence-based clinical tool to measure medical necessity, including level of are, molecular diagnostics and behavioral health criteria.
Developed by the Centers for Medicare & Medicaid Services, RAC contractors are authorized to correct improper payments for Medicare patients paid after Oct. 1, 2007. The contractors are charged with auditing past Medicare payments dating back to 2004 to determine if providers were overpaid, and to collect those overpayments.
"We are excited to see the power of our InterQual Criteria being used to increase RAC auditing efficiency across the country," said Rose Higgins, vice president of care management solutions for McKesson Health Solutions. "The national use of InterQual continues to broaden, creating a common ground for clinical decision-making between payers and providers. In addition to signing the three RACs, the majority of Medicare Administrative Contractors and QIOs have contracts to use InterQual, and we look forward to continuing to develop agreements with other government organizations."
Diversified is the RAC contractor for Region A, which covers all of New England, as well as New York, New Jersey, Pennsylvania, Delaware and Maryland. HealthDataInsights is in charge of Region D, which covers Iowa, Missouri, North and South Dakota, Nebraska, Kansas, Montana, Wyoming, Idaho, Utah, Arizona, California, Nevada, Oregon, Washington, Alaska and Hawaii. Connolly Healthcare is in charge of Region C, which covers Colorado, New Mexico, Texas, Oklahoma, Arkansas, Louisiana, Tennessee, Mississippi, Alabama, Georgia, Florida, North and South Carolina, Virginia and West Virginia.