Peer to Peer Pointers for Successful Prior Authorizations

Krystal Revai MD, MP discusses peer to peer pointers for assignment of appropriate levels of care for hospitalized patients

She defines in patient and observation levels of care, as well as how the guidelines for the use of InterQual and Milliman are different. She shares what clinicians can do to ensure that their patients are admitted under the appropriate level of care and what can be done if the insurance company disagrees with a determination that a member should be inpatient and downgrades them to observation.