Review Process. Introduction. InterQual Level of Care Criteria Outpatient Rehabilitation & Chiropractic Criteria
|
|
- Ezra Doyle
- 5 years ago
- Views:
Transcription
1 InterQual Level of Care Criteria Outpatient Rehabilitation & Chiropractic Criteria Review Process Introduction InterQual Outpatient Rehabilitation & Chiropractic Criteria support decisions about the appropriateness of therapy services and chiropractic care in the outpatient setting. Outpatient Rehabilitation & Chiropractic criteria subsets have been validated for use with adult, adolescent, or pediatric patients. (Outpatient Rehabilitation is for adult, adolescent, and school age patients. The Pediatric Rehabilitation subset is for medically complex pediatric patients. Chiropractic is for adult patients and adolescent patients.) Adult criteria are for review of patients 18 years of age or older; adolescent criteria are for review of patients 13 to < 18 years of age; school age criteria are for review of patients 5 to < 13 years of age; and the pediatric criteria are for patients < 18 years of age. Outpatient Rehabilitation & Chiropractic criteria subsets are organized by diagnosis (e.g., Carpal Tunnel Syndrome and Osteoarthritis, Shoulder). Outpatient treatment for both non-operative and postoperative conditions is addressed. Each subset includes review criteria for initial, ongoing, and discharge reviews. Important: The criteria reflect clinical interpretations and analyses and cannot alone either resolve medical ambiguities of particular situations or provide the sole basis for definitive decisions. The criteria are intended solely for use as screening guidelines with respect to the medical appropriateness of healthcare services and not for final clinical or payment determinations concerning the type or level of medical care provided, or proposed to be provided, to a patient. When evidence in the medical literature to support the effectiveness of an intervention or service is mixed or unclear, the criteria point reflects current best evidence and practice. It is the product of a peer review process involving multiple clinicians with diverse expertise in varied practice and geographic settings When conducting reviews, the issue of gender may be relevant. InterQual content contains numerous references to gender. Depending on the context, these references may refer to either genotypic or phenotypic gender. At the individual patient level, a variety of factors, including but not limited to gender identity and gender reassignment via surgery or hormonal manipulation, may affect the applicability of some InterQual criteria. This is most often the case with genetic testing and procedures that assume the presence of gender-specific anatomy. With these considerations in mind, all references to gender in InterQual have been reviewed and modified when appropriate. InterQual users should carefully consider issues related to patient genotype and anatomy, especially for transgender individuals, when appropriate. Copyright 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 1
2 Reference materials Reference materials are provided with the criteria and should be used to assist in the correct interpretation of the criteria. Abbreviations and Symbols List: Defines acronyms, abbreviations, and symbols used in the criteria. Bibliography: References cited in the clinical content. Clinical Revisions: Provide details of changes to InterQual Clinical Criteria. Drug List: Categorizes drug names and classes mentioned within the criteria. Index: Lists conditions and/or diagnoses and is designed to guide the user to the criteria subset where a specific condition or diagnosis may be found. Additionally, the Change Healthcare Customer Hub ( provides interactive support, answers to commonly asked questions, and links to other resources. Informational notes Informational notes provide information regarding best clinical practice, new clinical knowledge, explanations of criteria rationale, definitions of medical terminology, and current literature references. A note icon indicates one or more notes are associated with a criteria point. To view notes, click a note icon. How to conduct a review Outpatient Rehabilitation & Chiropractic Criteria include initial, ongoing, and discharge reviews. Initial Review and Ongoing Review criteria consist of objective clinical indicators and address therapeutic services delivered in the outpatient setting. The Initial and Ongoing rule requires All criteria to be met. The clinical indicators and services components include: Clinical presentation Rehabilitation potential For patients with a functional impairment who have a chronic or progressive illness without the expectation for improvement, refer to the Maintenance Therapy subset. Criteria in this subset can be used to validate the need for therapeutic services to maintain current functional status or prevent or slow further decline. Progressive therapy program (program components, treatment goals, and progress) Copyright 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 2
3 Functional status (e.g., mild, moderate, or severe limitation) and related visits within a designated time frame (e.g., 4 weeks). Discharge review is used to determine if the patient has reached a level of independence appropriate for safe discharge from outpatient treatment or that services may no longer be appropriate (e.g., worsening symptoms, poor rehabilitation potential). The Discharge Review rule requires One discharge criteria be met. The discharge criteria include: New onset / worsening of symptoms Patient is appropriate for an independent home exercise program Treatment goals met Functional plateau reached Poor rehabilitation potential How to conduct an initial review After the initial evaluation, to determine the appropriateness of services at the outpatient level, conduct an initial review: Obtain and review the initial evaluation Select a subset Select Initial Review criteria that apply to the case Take action based on review findings 1. Obtain and review the initial evaluation from the therapist or chiropractor. 2. Select the most appropriate criteria subset based on the patient s diagnosis. 3. Select Initial Review criteria based on the patient's clinical presentation, the documented treatment program, and functional status and determine if All criteria are met. Note the number of visits associated with the patient s functional status. 4. Take the appropriate action based on the review findings: Finding Initial Review rule met Action Approve the initial visits. Schedule the ongoing review, if appropriate. Copyright 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 3
4 Finding Initial Review rule not met Action Obtain additional information from the therapist, chiropractor, or referring physician. If additional information does not meet the corresponding Initial Review components, determine if the patient meets discharge criteria. If Discharge Review criteria are met, discuss patient self-management plan with therapist, chiropractor or physician. If there is no agreement regarding self-management, refer for secondary review. If Discharge Review criteria are not met, refer for secondary review. Review tips The initial review period includes the first 4 weeks of treatment. A week is defined as any 7-day period. Knowing which visit pattern to approve: The number of visits is based on the relevant functional status. More than one service requested: When more than one service is requested and will be provided by different disciplines (e.g., OT, PT, Chiro), the reviewer needs to review all services requested individually to avoid duplication of services. More than one clinical problem: When more than one clinical problem is present and will be treated by one provider, it is important to determine if the problems are related or isolated. Isolated problems should be reviewed separately and the appropriate number of visits should not exceed the maximum number of visits allowed for the more severe clinical problem. Related clinical problems may require treatment to multiple areas, but the underlying clinical problem and treatment approach are essentially the same. Example 1: Patient presents to physical therapy with low back pain (LBP) and an ankle sprain after sustaining a fall. The LBP is mild with few functional limitations and 4 visits indicated, yet the ankle sprain is severe, indicating 12 visits would be appropriate. The visits should address both complaints with the expectation that more treatment is required for the more severe condition. This is an example of two diagnoses presenting as isolated complaints, with both resulting from a single accident. Example 2: Patient presents to physical therapy with right and left hip pain due to osteoarthritis. Both hips should be treated and the visits should address both complaints with the expectations that more treatment is required for the more severe condition. This is an example of one diagnosis related to two areas of the body. New clinical problem(s): If a new injury or exacerbation occurs as a result of a diagnosis not related to the current treatment, conduct an initial review of the new diagnosis to determine if additional outpatient services are appropriate. Example 1: An initial review was conducted for Carpal Tunnel Syndrome and 4 visits were given for a mild limitation in function. The patient falls and injures his knee and is diagnosed with a ligamentous injury with a moderate limitation. The reviewer obtains evaluation information on the knee and conducts another initial review to determine the Copyright 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 4
5 appropriate number of visits. In many cases, another discipline or therapist may provide services to the patient, necessitating separate reviews; however, if the same provider delivers the care for both clinical problems, the appropriate number of visits should not exceed the maximum number of visits allowed for the more severe clinical problem. Example 2: A patient is receiving physical therapy for a rotator cuff injury. The patient is having continued symptoms and undergoes a surgical rotator cuff repair. Postoperatively, the patient is referred for physical therapy. The reviewer obtains the initial postoperative physical therapy evaluation information and conducts another initial review to determine the appropriate number of visits. The post surgical shoulder is considered a new clinical problem. Discharge review is provided to validate that the patient can be discharged from outpatient services when Initial Review criteria are not met. How to conduct an ongoing review Beyond the initial approved visits or after the last review period is completed, to validate the need for ongoing services at the outpatient level, conduct an ongoing review: Obtain and review clinical information Select the same criteria subset used during the initial review Select Ongoing Review criteria that apply to the case Take action based on review findings 1. Obtain and review the clinical information, including progress notes, treatment notes, physician notes or orders, imaging or x-ray reports, and other information, as needed. 2. Select the same criteria subset used during the initial review or the last review period. 3. Select Ongoing Review criteria and determine if All criteria are met (Clinical presentation, Rehabilitation potential, Progressive therapy program including progress toward meeting treatment goals, and Functional status). It is not necessary to meet the symptoms and findings subcriteria under clinical presentation if the diagnosis was confirmed during the initial review. Document the Ongoing Review criteria met. Note the number of visits associated with the patient s functional status. When reviewing for Ongoing treatment, there should be documented progress toward meeting goals since the initial review. In many cases, the patient s overall functional status may improve one level (e.g., evaluation revealed moderate limitation and at ongoing review, the patient has a mild limitation). If the functional level does not change, a closer review of the individual physical impairments may be needed. 4. Take the appropriate action based on the review findings: Copyright 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 5
6 Finding Ongoing Review rule met Ongoing Review rule not met Action Approve the ongoing visits. Schedule next/final ongoing review, if appropriate. Review Discharge Review criteria to determine if discharge is appropriate. Obtain additional information from the therapist, chiropractor, or referring physician. If additional information does not meet the corresponding ongoing review, determine if the patient meets discharge criteria. If Discharge Review criteria are met, discuss patient self-management plan with the therapist, chiropractor or physician. If there is no agreement regarding self-management, refer for secondary review. If Discharge Review criteria are not met, refer for secondary review. Review tips For Outpatient Rehabilitation, the ongoing review period (except pediatric rehabilitation) specifies 12 weeks (initial 4 weeks of treatment and up to 8 additional weeks ongoing) of treatment. Ongoing review for Pediatric Rehabilitation can be used more than once. The total duration of treatment is determined by local medical policies or benefits. For Chiropractic, the ongoing review period limits treatment to a total of 8 weeks (initial 4 weeks of treatment and up to 4 additional weeks ongoing). Ongoing review for day rehabilitation specifies weekly review for a total of 3 weeks (initial week of treatment and up to 2 additional weeks ongoing). If the reviewing organization begins to review for continuation of services after a predetermined number of visits have been used and the associated time period has lapsed, follow the Ongoing Review criteria. If the predetermined number of visits has been used prior to the recommended time period and additional visits are requested, secondary review is appropriate. A week is defined as any 7-day period. Knowing which visit pattern to approve: The number of visits is based on the functional status selected in the ongoing review. In most cases, the functional status should reflect progress and a decrease in the severity of functional limitation. New clinical problem(s): If a new injury or exacerbation occurs as a result of a diagnosis not related to the current treatment, conduct an initial review of the new diagnosis to determine if additional outpatient services are appropriate. Example: An initial review was conducted for Carpal Tunnel Syndrome and 4 visits were given for a mild limitation in function. The patient falls and injures his knee and is diagnosed with a ligamentous injury with a moderate limitation. The reviewer obtains evaluation information on the knee and conducts another initial review to determine the appropriate number of visits. In many cases, another discipline or therapist may provide Copyright 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 6
7 services to the patient, necessitating separate reviews; however, if the same provider delivers the care for both clinical problems, the appropriate number of visits should not exceed the maximum number of visits allowed for the more severe clinical problem. Discharge review is provided to validate that the patient is appropriate to be discharged from outpatient services when Initial or Ongoing Review criteria are not met. If the discharge occurs prior to the completion of the authorized treatment period, the discharge review is optional and can be used to determine the appropriateness of discharge. Secondary review When a case does not meet criteria, it is referred for a secondary review. A supervisor, a specialist (e.g., therapist, chiropractor), or a physician may conduct a secondary review. It is a matter of organizational policy to determine the qualifications of the reviewers as well as the extent to which secondary review(s) is performed to render a review outcome. The secondary reviewer determines the medical necessity of initial or ongoing care based on review of the medical record, discussions with the provider and referring physician, and by applying clinical experience. When is a secondary review appropriate? Review rules are not met. You have questions about the quality of care. What questions does a secondary review address? Does the patient require this level of care? What are the treatment options? Is there a quality-of-care question? Should this case by evaluated by a specialist? Secondary review steps 1. If the secondary reviewer agrees with the existing care plan, approve the visits and schedule the next review. 2. If the secondary reviewer does not agree with the requested visits or care plan, he or she discusses the self-management options for this patient with the provider or referring physician. If the provider agrees with the secondary reviewer, the provider continues care within the authorized or revised visit structure, facilitating discharge when indicated. Copyright 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 7
8 If the provider or ordering physician does not agree with the secondary reviewer, initiate action as directed by organizational policy. 3. Document the review outcome. Copyright 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 8
InterQual Level of Care Criteria Outpatient Rehabilitation & Chiropractic Criteria
InterQual Level of Care Criteria Outpatient Rehabilitation & Chiropractic Criteria Review Process Introduction InterQual Outpatient Rehabilitation & Chiropractic Criteria support decisions about the appropriateness
More information= = = = = = = = = = = = = INTERQUAL OUTPATIENT REHABILITATION AND CHIROPRACTIC CRITERIA
INTERQUAL OUTPATIENT REHABILITATION AND CHIROPRACTIC CRITERIA REVIEW REVIEW Copyright 2010 McKesson Corporation and/or one of its subsidiaries. All Rights Reserved. RP-1 REVIEW Copyright 2010 McKesson
More informationReview Process. Introduction. Reference materials. InterQual Imaging Criteria
InterQual Imaging Criteria Review Process Introduction As part of the InterQual Care Planning family of products, InterQual Imaging Criteria provide healthcare organizations with evidence-based clinical
More informationReview Process. Introduction. Reference materials. InterQual Specialty Referral Criteria
InterQual Specialty Referral Criteria Review Process Introduction As part of the InterQual Care Planning family of products, InterQual Specialty Referral Criteria provide healthcare organizations with
More informationINTERQUAL BEHAVIORAL HEALTH CRITERIA GERIATRIC PSYCHIATRY REVIEW PROCESS
INTERQUAL BEHAVIORAL HEALTH CRITERIA GERIATRIC PSYCHIATRY REVIEW PROCESS RP-1 RP-2 AGE PARAMETERS Geriatric Psychiatry Behavioral Health Criteria are for the review of patients who are ages 65 and older.
More informationINTERQUAL BEHAVIORAL HEALTH CRITERIA ADOLESCENT PSYCHIATRY REVIEW PROCESS
INTERQUAL BEHAVIORAL HEALTH CRITERIA ADOLESCENT PSYCHIATRY REVIEW PROCESS RP-1 RP-2 AGE PARAMETERS Adolescent Psychiatry Behavioral Health Criteria are for the review of patients who are ages 13 to 17
More informationReview Process. Introduction. Reference materials. InterQual SIM plus Criteria
InterQual SIM plus Criteria Review Process Introduction As part of the InterQual Care Planning family of products, InterQual SIM plus provide healthcare organizations with evidence-based clinical decision
More informationPOLICY AND PROCEDURE
PAGE: 1 of 10 SCOPE: Absolute Total Care departments PURPOSE: To provide guidelines for Medical Necessity of outpatient physical, occupational and speech therapy evaluation and treatment services. POLICY:
More informationCorporate Medical Policy
Corporate Medical Policy Continuous Passive Motion in the Home Setting File Name: Origination: Last CAP Review: Next CAP Review: Last Review: continuous_passive_motion_in_the_home_setting 9/1993 6/2018
More informationCombined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SAMPLE GROUP AGREEMENT
EOC #6 - Kaiser Foundation Health Plan, Inc. Southern California Region Combined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SAMPLE
More informationReimbursement Policy and Billing Guidelines for Chiropractic Services Effective April 1, 2006 for all BCBSMA Products (Revised September 2007)
Reimbursement Policy and Billing Guidelines for Chiropractic Services Effective April 1, 2006 for all BCBSMA Products (Revised September 2007) Policy Statement Blue Cross Blue Shield of Massachusetts (BCBSMA)
More informationNZ Organised Stroke Rehabilitation Service Specifications (in-patient and community)
NZ Organised Stroke Rehabilitation Service Specifications (in-patient and community) Prepared by the National Stroke Network to outline minimum and strongly recommended standards for DHBs. Date: December
More informationPHYSICAL MEDICINE AND REHABILITATION CSHCN SERVICES PROGRAM PROVIDER MANUAL
PHYSICAL MEDICINE AND REHABILITATION CSHCN SERVICES PROGRAM PROVIDER MANUAL NOVEMBER 2017 CSHCN PROVIDER PROCEDURES MANUAL NOVEMBER 2017 PHYSICAL MEDICINE AND REHABILITATION Table of Contents 30.1 Enrollment......................................................................
More informationMountain State Blue Cross Blue Shield (Otherwise referred to as the Plan) CORPORATE POLICY AND PROCEDURES
Mountain State Blue Cross Blue Shield No: MP Supersedes No.: N/A Original Effective Date: 0/0/0 Standards: Date of Last Review: 0//0 Related Policies: Date of Last Revision: DRAFT ( ) INTERIM ( ) FINAL
More informationMedical Necessity Guidelines: Outpatient Physical Therapy, Occupational Therapy and Speech Therapy
Medical Necessity Guidelines: Outpatient Physical Therapy, Occupational Effective: January 1, 2018 Clinical Documentation and Prior Authorization Required Applies to: 2273290 1 Outpatient Physical, Occupational
More informationPrimary Chiropractic and Physical Therapy Soft Tissue Treatment Guidelines
Primary Chiropractic and Physical Therapy Soft Tissue Treatment Guidelines 1. Preface The WCB Health Services Unit developed these guidelines for soft tissue injuries, with input from biomechanical health
More informationInterQual Level of Care Outpatient Rehabilitation & Chiropractic Criteria 2010 Clinical Revisions
InterQual Level of Care Outpatient & Criteria 2010 Clinical Revisions Criteria Evidence Review and Update McKesson Health Solutions is committed to keeping the InterQual product suite current and accurate.
More informationProving Medical Necessity, Functional Improvement, and Maintenance Care By Dr. Ron Short, DC, MCS-P, CPC, CPCO
Proving Medical Necessity, Functional Improvement, and Maintenance Care By Dr. Ron Short, DC, MCS-P, CPC, CPCO The Big Three Problems The three major complaints that Medicare has regarding chiropractic
More informationFamily Coverage Self-Only Coverage Amounts Per Accumulation Period (a Family of one Member) or more Members
Benefit Summary 128742 & 35995 ACWA JPIA Principal Benefits for Kaiser Permanente Traditional HMO Plan (1/1/18 12/31/18) Accumulation Period The Accumulation Period for this plan is 1/1/18 through 12/31/18
More informationChiropractic Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SANTA CLARA COUNTY SCHOOLS INSURANCE GROUP
EOC #82 - Kaiser Foundation Health Plan, Inc. Northern California Region Chiropractic Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SANTA CLARA COUNTY SCHOOLS
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services News Flash Looking for the latest Medicare Fee-For-Service (FFS) information? Then subscribe to a Medicare FFS Provider
More informationTRIBUNAL D APPEL EN MATIÈRE DE PERMIS
LICENCE APPEAL TRIBUNAL Safety, Licensing Appeals and Standards Tribunals Ontario TRIBUNAL D APPEL EN MATIÈRE DE PERMIS Tribunaux de la sécurité, des appels en matière de permis et des normes Ontario Tribunal
More informationYour Kaiser Permanente CHIROPRACTIC benefits
Provided by American Specialty Health Plans of California, Inc. (ASH Plans) Your Kaiser Permanente CHIROPRACTIC benefits When you need chiropractic care, follow these simple steps: 1. Find an ASH Plans
More informationPage 1 of 6. Appendix 1
Page 1 Appendix 1 Rotation Objectives and Schedule 1. Introductory Month 4 weeks 2. Total Joints 4 weeks a. Diagnosis and management of hip and knee arthritis b. Indications for surgery c. Implant selection;
More informationChiropractic. Information for GPs and healthcare professionals
Chiropractic Information for GPs and healthcare professionals What is chiropractic? Diagnosis, assessment and treatment Chiropractic is a primary healthcare profession that specialises in the diagnosis,
More informationChiropractic Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SYNOPSYS AND NAMED SUBSIDIARIES
EOC #6 - Kaiser Foundation Health Plan, Inc. Northern California Region Chiropractic Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SYNOPSYS AND NAMED SUBSIDIARIES
More informationPrincipal Benefits for Kaiser Permanente Senior Advantage (HMO) with Part D (7/1/18 6/30/19)
Benefit Summary 35876D 35876 SCHOOLS INSURANCE GROUP #35876 Principal Benefits for Kaiser Permanente Senior Advantage (HMO) with Part D (7/1/18 6/30/19) Plan Out-of-Pocket Maximum For Services subject
More informationGoals and Objectives for the Orthopaedic Surgery Resident McGill Orthopaedic Sports Medicine (SMH) Knee & Shoulder Surgery
Goals and Objectives for the Orthopaedic Surgery Resident McGill Orthopaedic Sports Medicine (SMH) Knee & Shoulder Surgery PGY 1 & 2 1. Medical Expert A. Basic Science a) General Knowledge of functional
More informationSample page. For the Physical Therapist An essential coding, billing and reimbursement resource for the physical therapist CODING & PAYMENT GUIDE
CODING & PAYMENT GUIDE 2019 For the Physical Therapist An essential coding, billing and reimbursement resource for the physical therapist Power up your coding optum360coding.com Contents Getting Started
More informationMEDICAL POLICY Children's Intensive Behavioral Service/ Applied Behavioral Analysis (ABA)
POLICY: PG0335 ORIGINAL EFFECTIVE: 12/17/15 LAST REVIEW: 07/10/18 MEDICAL POLICY Children's Intensive Behavioral Service/ Applied Behavioral Analysis (ABA) GUIDELINES This policy does not certify benefits
More informationEffectiveness Of Manual Physical Therapy For Painful Shoulder Conditions A Systematic Review
Effectiveness Of Manual Physical Therapy For Painful Shoulder Conditions A Systematic Review Keeping Manual Physical Therapy In Effectiveness Manual Therapy of manual physical therapy for painful shoulder
More informationNew Authorization Requirements for Outpatient Physical, Occupational, and Speech Therapy (Eff. 1/1/18)
New Authorization Requirements for Outpatient Physical, Occupational, and Speech Therapy (Eff. 1/1/18) Effective January 1, 2018, Martin s Point Health Care will require providers to submit initial and
More informationCombined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SAMPLE GROUP AGREEMENT
EOC #6 - Kaiser Foundation Health Plan, Inc. Southern California Region Combined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SAMPLE
More informationService Information S. X Home X Community Specify other: 45 minutes 36 X Home X Community Other Specify other:
Scenario: Xavier s initial IFSP team consisted of an EIS and OT. The team recommended SST three times a and OT once a. Sally, Xavier s mom, wants more OT. The team believed Xavier would benefit from PT
More informationCombined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SAMPLE GROUP SAMPLE
EOC #4 - Kaiser Foundation Health Plan, Inc. Northern California Region Combined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for GROUP
More informationGoals and Objectives for the Orthopaedic Surgery Resident McGill Orthopaedic Sports Medicine and Minimally Invasive (MGH & Shriners) Junior Residents
Goals and Objectives for the Orthopaedic Surgery Resident McGill Orthopaedic Sports Medicine and Minimally Invasive (MGH & Shriners) Junior Residents The following document is intended to guide you in
More informationPrincipal benefits for Kaiser Permanente Traditional HMO Plan (10/1/18 9/30/19)
Disclosure Form SISC - Self Insured Schools Of California Home Region: California Principal benefits for Kaiser Permanente Traditional HMO Plan (10/1/18 9/30/19) Accumulation Period The Accumulation Period
More information2019 COLLECTION TYPE: MIPS CLINICAL QUALITY MEASURES (CQMS) MEASURE TYPE: Patient Reported Outcome High Priority
Quality ID #220 (NQF 0425): Functional Status Change for Patients with Low Back Impairments National Quality Strategy Domain: Communication and Care Coordination Meaningful Measure Area: Patient Reported
More informationPrincipal Benefits for Kaiser Permanente Traditional Plan (10/1/16 9/30/17)
Benefit Summary SISC-SELF INSURED SCHOOLS OF CALIFORNIA Principal Benefits for Kaiser Permanente Traditional Plan (10/1/16 9/30/17) The Services described below are covered only if all of the following
More informationA Patient s Guide to Adult Distal Radius (Wrist) Fractures
A Patient s Guide to Adult Distal Radius (Wrist) Fractures Suite 11-13/14/15 Mount Elizabeth Medical Center 3 Mount Elizabeth Singapore, 228510 Phone: (65) 6738 2628 Fax: (65) 6738 2629 1 DISCLAIMER: The
More information2018 Clinical Revisions
InterQual Guidelines for Surgery and Procedures Performed in the Inpatient Setting 2018 Clinical Revisions Review and Incorporation of Recent Medical Literature Change Healthcare is committed to keeping
More informationJanuary 1, 2018, through December 31, 2018
EOC #16 - Kaiser Foundation Health Plan, Inc. Northern and Southern California Regions Combined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage
More informationGENERAL Why is MVP Health Care (MVP) implementing an MSK Program focused on hip, knee, shoulder and spine surgeries?
Magellan Healthcare 1 Musculoskeletal Care Management (MSK) Program Hip, Knee, Shoulder & Spine Surgeries Frequently Asked Questions (FAQ s) For MVP Health Care Ordering Physicians Question GENERAL Why
More informationMSK Rehab Definitions Framework - hip fractures Self assessment Survey Outpatient Rehab
MSK Rehab Definitions Framework - hip fractures Self assessment Survey Outpatient Rehab In response to a changing rehab landscape in which rehabilitation is offered in many different settings with variations
More informationPhysical Therapy Diagnosis and Documentation Tips
1 This tool is designed to assist the Physical Therapist in consultation with the physician, in the selection of an appropriate according to Medicare coverage guidelines. The documentation tips will add
More information2017 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process
Measure #109: Osteoarthritis (OA): Function and Pain Assessment National Quality Strategy Domain: Person and Caregiver-Centered Experience and Outcomes 2017 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY
More informationMORE FOR BACKS PROGRAM. User guide for chiropractors and chiropractic code list (ICD-10-AM codes)
MORE FOR BACKS PROGRAM User guide for chiropractors and chiropractic code list (ICD-10-AM codes) APRIL 2017 WELCOME TO THE MORE FOR BACKS PROGRAM This program reimburses 100% of the agreed charge for an
More informationNEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES POLICY GUIDELINES
NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES POLICY GUIDELINES Version 2010-1 June 10, 2010 Page 1 of 8 Table of Contents SECTION I REQUIREMENTS FOR PARTICIPATION IN MEDICAID. 3 PROVIDER/QUALIFYING
More informationDepartment of Orthopaedics and Rehabilitation
Rotation: Department of Orthopaedics and Rehabilitation Resident Year-In-Training: Attending Physicians Rotation-Specific Objectives for Resident Education 1. Robert Orfaly, M.D., FRCS(C) Orthopaedic Surgeon,
More informationDENOMINATOR: All patient visits for patients aged 21 years and older with a diagnosis of OA
Quality ID #109: Osteoarthritis (OA): Function and Pain Assessment National Quality Strategy Domain: Person and Caregiver-Centered Experience and Outcomes 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY
More informationMORE FOR BACKS PROGRAM. User guide for chiropractors and chiropractic code list (ICD-10-AM codes)
MORE FOR BACKS PROGRAM User guide for chiropractors and chiropractic code list (ICD-10-AM codes) MAY 2018 WELCOME TO THE MORE FOR BACKS PROGRAM This program reimburses 100% of the agreed charge for an
More informationGroup ID: Contract: 1 Version: 11 EOC Number: 8. January 1, 2017, through December 31, 2017
EOC #8 - Kaiser Foundation Health Plan, Inc. Northern California Region Combined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for MARSH
More informationNOVA SCOTIA WORKERS COMPENSATION APPEALS TRIBUNAL
NOVA SCOTIA WORKERS COMPENSATION APPEALS TRIBUNAL Appellant: [X] (Worker) Participants entitled to respond to this appeal: [X] (Employer) and The Workers Compensation Board of Nova Scotia (Board) APPEAL
More information2019 COLLECTION TYPE: MIPS CLINICAL QUALITY MEASURES (CQMS) MEASURE TYPE: Patient Reported Outcome High Priority
Quality ID #223 (NQF 0428): Functional Status Change for Patients with General Orthopedic Impairments National Quality Strategy Domain: Communication and Care Coordination Meaningful Measure Area: Patient
More informationYour Kaiser Permanente CHIROPRACTIC and ACUPUNCTURE benefits
Provided by American Specialty Health Plans of California, Inc. (ASH Plans) Your Kaiser Permanente CHIROPRACTIC and ACUPUNCTURE benefits When you need chiropractic or acupuncture care, follow these simple
More informationChiropractic Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for COUNTY OF SACRAMENTO
EOC #10 - Kaiser Foundation Health Plan, Inc. Northern California Region Chiropractic Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for COUNTY OF SACRAMENTO Group
More informationGENERAL Why did Tufts Health Plan implement a Spinal Conditions Management Program and why is it expanding to include joint surgeries?
National Imaging Associates, Inc. (NIA) Spinal Conditions Management Program and Joint Surgery Program Frequently Asked Questions (FAQ s) For Tufts Health Plan Ordering Physicians Question GENERAL Why
More informationSummary of Benefits Chart for Kaiser Permanente Senior Advantage (HMO) with Part D (10/1/17 9/30/18)
SISC - KPSA $0 Summary of Benefits Chart for Kaiser Permanente Senior Advantage (HMO) with Part D (10/1/17 9/30/18) Plan Out-of-Pocket Maximum For Services subject to the maximum, you will not pay any
More informationPATIENT ENTRANCE FORM
PATIENT ENTRANCE FORM Name _ Date Address City/ Province Postal Code Home Telephone Work Telephone Email Address Would like email reminders for appointments? Yes No Date of Birth (Day/Month/Year) Age Marital
More informationOccupational Therapy. Occupational Therapy Payment Policy Page 1
Occupational Therapy I. Policy Occupational therapy is a form of rehabilitation therapy involving the treatment of neuromusculoskeletal function through the use of specific tasks or goal-directed activities
More informationCombined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SAMPLE GROUP
EOC #4 - Kaiser Foundation Health Plan, Inc. Southern California Region Combined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SAMPLE
More informationCertificate for Advanced Practice in Hand Therapy
Certificate for Advanced Practice in Hand Therapy Curriculum Effective: March 2016 EBP 6100 Evidence-based Practice I (15 hours/1 credit) ONLINE SELF-PACED, SELF-STUDY This course is designed to improve
More informationA Patient s Guide to Peroneal Tendon Subluxation. Foot and Ankle Center of Massachusetts, P.C.
A Patient s Guide to Peroneal Tendon Subluxation Welcome to Foot and Ankle Center of Massachusetts, where we believe in accelerating your learning curve with educational materials that are clearly written
More informationDepartment of Orthopaedics
OUTCOMES DIVISION OF MEDICINE Department of Orthopaedics About Cleveland Clinic Florida Cleveland Clinic Florida s medical staff are dedicated physicians who have joined the clinic as salaried doctors
More informationAttention STAR Providers: Physical, Occupational, and Speech Therapy Benefits for All Ages to Change for Texas Medicaid September 1, 2017
Attention STAR Providers: Physical, Occupational, and Speech Therapy Benefits for All Ages to Change for Texas Medicaid September 1, 2017 Effective for dates of service on or after September 1, 2017, physical
More informationChiropractic ICD-10 Common Codes List
Chiropractic ICD-10 Common Codes List This is a preliminary list of Common ICD-10 Codes for chiropractic diagnoses. This is a common code list to be used as a guide for coding and is not intended to represent
More informationPlease make sure that you complete a self-assessment survey for each type of rehab program that your organization provides.
Oncology Rehab s Framework Self-Assessment Tool Inpatient Rehab Survey for Oncology Rehab INTRODUCTION: In response to a changing rehab landscape in which rehabilitation is offered in many different settings
More informationICD-10 CM Training. Orthopaedic
ICD-10 CM Training Orthopaedic ICD-10-CM Compliance Dates ICD-10-CM will be valid for dates of service on or after October 1, 2015 Outpatient dates of service of October 1, 2015 and beyond. Inpatient hospital
More informationKapi'olani Community College Courses , O-P, page 1
Kapi'olani Community College Courses 2016 2017, O-P, page 1 OCCUPATIONAL THERAPY ASSISTANT OTA 110 Introduction to Occupational Therapy (3) Comment: Letter grade only. OTA 110 may not be audited. OTA 110
More informationThe Arizona Quarterly Spine
Summer 2010 Patient Edition P a g e 1 SpineScottsdale Physical Therapy Newsletter The Arizona Quarterly Spine What is the Arizona Quarterly Spine? The Arizona Quarterly Spine is a quarterly publication
More informationPhysical Therapy. Physical Therapy Payment Policy Page 1
Physical Therapy I. Policy University Health Alliance (UHA) will reimburse for physical therapy when it is determined to be medically necessary and when it meets the medical criteria guidelines (subject
More information2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process
Quality ID #109: Osteoarthritis (OA): Function and Pain Assessment National Quality Strategy Domain: Person and Caregiver-Centered Experience and Outcomes 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY
More informationThe Subcommittee have specified National Skill Standard Nuad Thai practitioner (Traditional Thai Massager )
The have specified National Skill Standard Nuad Thai practitioner (Traditional Thai Massager ) 1. Mrs.Yuwadee Chobpattana Chairman Department of Health Service Support, Ministry of Public Health. 2. Miss
More informationLocal Coverage Article for Chiropractic Services (A47798) Contractor Information. Article Information. Contractor Name. Contractor Numbers
Local Coverage Article for Chiropractic Services (A47798) Print Contractor Information Contractor Name Novitas Solutions, Inc. Contractor Numbers 12501, 12502, 12101, 12102, 12201, 12202, 12301, 12302,
More informationGONSTEAD. Think of an Adjustment as " Tuning " a piano, Adjusting each String so it produces the Perfect Tone. DIVERSIFIED
We use a number of highly-effective adjusting approaches to help improve spinal biomechanics and reduce nervous system interference. The approach we use is based on our judgment and years of experience.
More informationThis section includes billing guidelines and treatment information for alternative care providers including:
Alternative care Alternative care overview This section includes billing guidelines and treatment information for alternative care providers including: Acupuncturists/East Asian Medicine Practitioners
More informationThe evidence for SMT in CLBP
The evidence for SMT in CLBP Peter Tuchin BSc, GradDipChiro, DipOHS PhD FACC Associate Professor, MU (1991 - ) Past President, COCA 1 Peter Tuchin Peter Tuchin 2 WCA 2007 Peter Tuchin 3 Number of injuries
More informationA Patient s Guide to Viscosupplementation for Osteoarthritis of the Knee
A Patient s Guide to Viscosupplementation for Osteoarthritis of the Knee Iain is a specialist in musculoskeletal imaging and the diagnosis of musculoskeletal pain. This information is provided with the
More informationReport to the Social Services Appropriations Subcommittee
Report to the Social Services Appropriations Subcommittee Medicaid Coverage and Reimbursement for Outpatient Physical Therapy and Outpatient Occupational Therapy Prepared by the Division of Medicaid and
More informationColumbia/NYOH Department of Orthopaedics Shoulder, Elbow, and Sports Medicine Service Competency Requirements
Updated 2/8/10 Columbia/NYOH Department of Orthopaedics Shoulder, Elbow, and Sports Medicine Service Competency Requirements Patient Care Faculty will evaluate the resident s ability to obtain History,
More informationD.L. Hart Memorial Outcomes Research Grant Program Details
Purpose D.L. Hart Memorial Outcomes Research Grant Program Details Focus on Therapeutic Outcomes, Inc. (FOTO) invites applications for the D.L. HART Memorial Outcomes Research Grant. FOTO is seeking proposals
More informationBrisbin Family Chiropractic
Information reviewed with patient: Dr. Initials Today s Date Brisbin Family Chiropractic Name: Sex: Male Female Address: City: Postal Code: Home Ph# Work# Ext# Cell# Preferred number (circle one) Home
More informationInterQual 2013 Release Deep Dive Overview of Acute Adult Criteria Changes
InterQual 2013 Release Deep Dive Overview of Acute Adult Criteria Changes Laura McIntire, RN, MA, CPHM Product Manager, InterQual Chrissy Finn, RN, BSN, MSN, CPHM Clinical Lead Elisia Willette, RN, BSN,
More informationICF-based Clinical Practice Guidelines for Common Musculoskeletal Conditions. CSM Board of Directors Meeting. February 2017
ICF-based Clinical Practice Guidelines for Common Musculoskeletal Conditions CSM Board of Directors Meeting February 2017 Submitted by: Joe Godges DPT*, Christine McDonough PT, PhD*, and Brenda Johnson**
More informationCover page DRAFT PROCEDURAL PAIN MANAGEMENT
Cover page DRAFT PROCEDURAL PAIN MANAGEMENT 3 April 2018 Please find attached the DRAFT privileges for PROCEDURAL (INTERVENTIONAL) PAIN MANAGEMENT. THE PANEL: This draft was developed by a provincial panel
More information9400 West Higgins Road, Rosemont Illinois January 2017
Quality Newsletter 9400 West Higgins Road, Rosemont Illinois 60018 847.823.7186 www.aaos.org January 2017 Solicitations Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the
More information*FEEL FREE TO ASK YOUR LASER THERAPIST THE TOTAL COST OF YOUR TREATMENT PRIOR TO INITIATION.
FEE SCHEDULE & POLICY (OHIP) Meditech Rehabilitation Centres Inc. provides the following services: Updated: 19Oct17 1. Laser Therapy 2. Massage Therapy 3. Physiotherapy 4. Chiropractic Therapy 5. Exercise
More informationMedical Necessity Criteria
Medical Necessity Criteria 2016 Effective January 1, 2016 New Directions Behavioral Health P.O. Box 6729 Leawood, KS 66206-0729 www.ndbh.com Page 1 of 67 Introduction... 4 Medical Necessity... 4 Using
More informationNeurosurgery (Orthopaedic PGY-1) Goals. Objectives
Neurosurgery (Orthopaedic PGY-1) Length: 1 month of PGY-1 (Orthopaedic Designated Residents) or 1 month of PGY-2, -3, or -4 year Location: The Queen's Medical Center Primary Supervisor: William Obana,
More informationTerms of Acceptance:
Terms of Acceptance: When a patient seeks chiropractic health care and we accept them for such care, it is essential for us both to be working towards the same objective. Chiropractic has only one goal:
More informationMagellan Health Care 2018 Hip, Knee and Shoulder Surgery Authorization and CPT Code Reference Guide
Magellan Health Care 2018 Hip, Knee and Shoulder Surgery Authorization and CPT Code Reference Guide 1. PROCEDURES WITHIN PROCEDURES Does the ordering surgeon need a separate request for all hip, knee and
More informationPrimary (First) Complaint and Location
Name: : File #: Case Type: Sex: Birth : Age: Social Security #: Address: Residence and Mailing City State Zip Code Home Phone: Mobile Phone: Email: Occupation: Employer: Work Phone: Marital Status: S M
More informationPrincipal Benefits for Kaiser Permanente Traditional HMO (1/1/16 12/31/16)
Benefit Summary 128742, 35995 ACWA/JPIA Principal Benefits for Kaiser Permanente Traditional HMO (1/1/16 12/31/16) The Services described below are covered only if all of the following conditions are satisfied:
More informationMedicare Documentation Guidelines For Physical Therapy 2011
Medicare Documentation Guidelines For Physical Therapy 2011 As we move right along with our review of documentation strategies, this week we will for Medicare Part B and for carriers who follow Medicare
More information4. The time limit, not less than thirty (30) calendar days, for requesting a Hearing in writing.
SUBJECT: SECTION: CREDENTIALING POLICY NUMBER: CR-05B EFFECTIVE DATE: 04/13 Applies to all products administered by The Plan except when changed by contract Application When the Corporate Credentialing
More informationChronic conditions explained
Chronic conditions explained The limits of your cover for treatment of chronic medical conditions April 2015 Contents Undertanding chronic conditions Why it s important for you to understand 3 about chronic
More informationChiropractic Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for ADOBE SYSTEMS, INC.
EOC #2 - Kaiser Foundation Health Plan, Inc. Northern California Region Chiropractic Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for ADOBE SYSTEMS, INC. Group ID:
More informationHip $5,200. Wrist or Elbow $1,430 $715. Toe or Finger $390 $195. (except toes/heel), Wrist,
High 24 Hour Module 1 Accident Emergency Treatment Accident Emergency Treatment Benefit For physician treatment and X-rays in a hospital or doctor's office within 96 hours of the accident. Major Diagnostic
More information