MCAP™ Clinical Review Criteria For Payers

MCAP™ provides unsurpassed cost containment assurance by:

• Consistently enabling appropriate patient placement;
• Identifying opportunities to move patients through the continuum of care in the least amount of time, according to best practice standards;
• Ensuring that admissions and discharges are appropriate;
• Enabling staff to make accurate, timely decisions with information that is readily available; and by
• Providing meaningful management information that enables hospital staff to clearly identify reasons for patient movement delays.

As payment moves to a case methodology-basis (DRG), retrospective analysis of non-qualified days gives payors a tool to use in negotiations with hospitals on base rate. For example, if a hospital wants a 10% increase in base rate but has a 20% non-qualified rate, the payor could refuse to give more than a couple of percent until the non-qualified rate decreases to a reasonable threshold.

MCAP™ Clinical Review Criteria Reduces Length of Stay

Providers regularly report that they are able to significantly reduce length of stay by switching to MCAP Clinical Review Criteria. Providers also report that communications with payers also improves by switching to MCAP because ambiguity is eliminated—quick, accurate decisions can be made using MCAP, regardless of complexity or even co-morbidities, using the physician's plan of care and regularly charted information.

MCAP™ Clinical Review Criteria provides Clear and Accurate Information

Payers thus have certainty with MCAP—cases reviewed with MCAP Clinical Review Criteria are clear, well documented and accurate. Information provided by the CritView workflow solution enables payers to quickly generate claim response letters that are clear, well supported and consistently defensible. Switching to MCAP will mean faster, more reliable, more successful communications with providers, which translates directly to bottom line improvement. Isn't that the goal of case review criteria? Contact us to schedule a demonstration and experience the difference of MCAP Clinical Review Criteria yourself.