New patient admissions procedures at GHSU should simplify billing and ease third-party payer interactions. The process, called Utilization Review, will determine a patient’s billing status based on criteria developed by the evidence-based software, InterQual.
“This process should help physicians ensure that our patients have the correct status for billing,” said Dr. William Kanto, Interim Chief Medical Officer for GHS Medical Center. “Status determination has become an entire field of expertise, and those guidelines change annually. The goal is for the Utilization Reviewers, who are educated with this knowledge, to make the determination.”
The process will be phased in gradually, beginning in the Emergency Department. A utilization reviewer will determine billing status within 16 hours of a physician’s order to admit an emergency patient. Physicians must still approve the status – the sooner, the better. Status can be corrected after discharge on managed-care patients only.
For more information during regular business hours, call Utilization Review at 706-721-9455.
For information after regular business hours, call Carol Howard at 706-721-9553.