eQSuite is our proprietary web-based, HIPAA compliant prior authorization system which offers providers 24/7 accessibility to the information they need.
#1 How to Improve your DRG Review Outcome – Helpful FAQs from eQHealth Solutions
Please provide supportive rationale for inpatient admission on the day of admission, including presenting signs and symptoms and medication administration (especially intravenous fluids and medications) as well as all other treatments or interventions. Please provide the patients previous medical history, including outpatient management, as relevant to the admission. For surgical admissions, please clarify if the request is for a pre-op day or day of surgery. If the patient is being converted from observation to inpatient, please provide supportive rationale for the day the patient is converted to inpatient.
# 2 How to Improve your Undocumented Citizen Review Outcome
These reviews are for consideration of the clinical support of a life threatening emergency requiring acute admission and the determination of dates covered is through the stabilization of that emergency.
Clinical supporting documentation should include relevant past medical history; the reason for admission to the hospital with focus on the emergent condition and all interventions delivered to relieve that emergent situation. Daily supporting documentation should address the need for continued inpatient treatment. Daily documentation should include, at a minimum, interventions performed and medication administration. Documentation in the record of when the health care team identifies stabilization of the emergent condition occurs is helpful as the staff caring for the recipient has the most knowledge of the status of the recipient.
If patient has history of End Stage Renal Disease or presents with Acute Renal Disease the supporting documentation should indicate the first date of dialysis and all subsequent dates of dialysis during that hospital stay.
# 3 How to Improve your ADI Review Outcome
Provide a Physician Order for image study requested that is signed by an ARNP or PA.*note electronic signatures are acceptable as long as the signature states Electronically Signed*. Provide current up to date clinical rationale supportive of the image study being requested.
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