Overview
The Alabama Inpatient Quality Assurance Program provides review services to help ensure that Alabama Medicaid's resources are used effectively and appropriately.
The program's inpatient review services are performed by the Arkansas Foundation for Medical Care (AFMC), under contract with the Alabama Medicaid Agency, and include:
- Retrospective inpatient admission and continued stay review
- Hospital UR (Utilization Review) plans review
- Hospital MCE (Medical Care Evaluation) studies review
AFMC is a physician-sponsored, not-for-profit, health care quality improvement organization (QIO). Its review department is staffed by registered nurses who are licensed in the state of Alabama. Review managers, who oversee the other nurse reviewers, are Certified Professionals in Utilization Review (CPUR). All required physician review is performed by physicians licensed in the state of Alabama.
What's new in review...
Alabama Medicaid have released two new ALERT Memo's about the Adverse Event Policy and Utlilization Review Policy.
RE: Utilization Review Policy
Effective for admissions on or after July 1, 2010, Medicaid will require hospitals to report dates that do not meet InterQual Adult and Pediatric Medical Criteria and Alabama Medicaid Local Policy on the UB-04 claim form. The following is approved policy that will be a part of Medicaid's Billing Manual and Administrative Code. See policy here (pdf).
RE: Adverse Events Policy
Effective July 1, 2010, Medicaid will require hospitals to report Adverse Events. The following is approved policy that will be a part of Medicaid's Billing Manual and Administrative Code.
See policy here (pdf).
Adding Organizational Policies to
the CareEnhance Review
Manager Program
Alabama Medicaid Org Policies
2010 Instructions (PDF) | Instructions -Slide view (PDF)
|
