Acute Care InpatientReview Criteria Guidelines

 More than 350 guidelines that contain acute care inpatient review criteria with MS-DRG and APR-DRG Length of Stay data.

 Evidence-based, with comprehensive reference links.

 Provides utilization management and claims departments with essential information to assist in medically-necessary benefit determinations.

 Includes a section entirely devoted to Managing Unplanned Readmissions, which includes issues, innovative programs, resources and strategies needed to manage CMS targeted readmission diagnoses and avoid financial penalties.

 Detailed review criteria by MS-DRG focus on medical necessity and appropriateness of care.

 Search guidelines by DRG, CPT/HCPCS, ICD-9 or keyword.

Guidelines

  • MDC 0 - Stem Cell and Organ Transplantation
  • MDC 1 - Diseases and Disorders of the Nervous System
  • MDC 2 - Diseases and Disorders of the Eye
  • MDC 3 - Diseases and Disorders of the Ear, Nose, Mouth and Throat
  • MDC 4 - Diseases and Disorders of the Respiratory System
  • MDC 5 - Diseases and Disorders of the Circulatory System
  • MDC 6 - Diseases and Disorders of the Digestive System
  • MDC 7 - Diseases and Disorders of the Hepatobiliary System and Pancreas
  • MDC 8 - Diseases and Disorders of the Musculoskeletal System and Connective Tissues
  • MDC 9 - Diseases and Disorders of the Skin, Subcutaneous Tissue and Breast