Medical Necessity & Charting Guidelines

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InterQual Guidelines for Medical Necessity Utilized for Medicare patient Acute Care inpatient or Observation – Severity of Illness (SI) – Intensity of Service (IS) Used for Adult and Pediatric Services Offers Discharge Screens Criteria are specific for – Body Systems: Neuro, Cardiac, etc. – Care Units: ICU, Intermediate, Medical, Monitored bed 5
InterQual Guidelines for Medical Necessity Criteria for Alternative Level Of Care (ALOC) – Long Term acute Care – Rehab – SNF: Skilled Nursing facility – Hospice: Not limited to cancer patient – Home Health Reference copy in Library 6
Page 1 and 2: Medical Necessity & Charting Guidel
Page 3: Nationally Recognized Industry Guid
Page 7 and 8: Intensity of Service (IS) What What
Page 9 and 10: InterQual® - Alternate Level Of Ca
Page 11 and 12: DOCUMENTATION It is very important
Page 13 and 14: Charting Guidelines If a patient i
Page 15 and 16: Charting Guidelines Avoid charting
Page 17 and 18: Do Chart … Why the patient remai
Page 19 and 20: Charting Guidelines Do chart in th
Page 21 and 22: Timely Follow Up If you are part o

Medical Necessity & Charting Guidelines

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