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Emergency Care Management 2009
Apollo Managed Care Consultants, Jan 2009, Pages: 92
A 92-page toolbox of guidelines, benefit interpretations, policies and procedures for the effective management of appropriate and medically necessary emergency and urgent care services. Includes strategies for after-hours, emergency care, plus review criteria guidelines to develop an effective after-hours and emergency care program that will provide quality-driven care and meet most coverage determinations. Also included is psychiatric care in the ER, trauma center checklists. References and resources include links to emergency care protocols and guidelines and other web resources.
This ‘single topic’ medical guideline and review criteria has been developed to provide a representative model for common, acceptable, customary, reasonable and necessary managed care contract benefit interpretations and objective evidence-based review for authorization (or denial) of services. Each guideline must be reviewed by the medical policy committee of the HMO or contracted/delegated medical group, modified and adapted, as appropriate. It is strongly recommended that all applicable documents that will be used to manage medical care in the organization be sent to relevant providers for review and comment prior to implementation. This will always promote an understanding of the guideline, avoid compliance issues, and frequently improve the document by additional input. Cost effective health care is quality driven (true quality, that is; not excessive care) and attention must always be focused on the issues that will result in optimal medical/surgical outcomes in a specific local medical environment.
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