Apollo Adds Severity of Illness/Intensity of Service (SI/IS) Guideline
What is Severity of Illness/Intensity of Service (SI/IS)?
Severity of Illness/Intensity of Service (SI/IS) criteria provide an objective generic framework to establish the medical necessity for inpatient hospital care that is superior to generalized clinical pathways, diagnostic-related groups, or disease staging. Severity of Illness/Intensity of Service not only establishes a basis for hospital care, but also the level of care within the hospital (i.e., observation stay, inpatient admission, or a critical care service).
SI/IS criteria can be applied to psychiatric as well as medical-surgical care. These concepts are applicable to the care of individuals of any age.
MS-DRG and APR-DRG length of stay systems are statistical averages of data obtained from large populations admitted for hospital care. This data cannot be rigidly applied to medically necessary hospital-based care for a specific patient.
Severity of illness must be established before it is possible to review for intensity of service. Documentation must include the current clinical status/dysfunction, risk of deterioration, comorbidities that contribute to medical risk and care requirements.
This new guideline can be found in Apollo's Medical Review Criteria for Managing Care and Acute Care Inpatient Review Criteria Guidelines. Contact us for more information or to set up a demo.