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UM is the evaluation of the appropriateness and medical necessity of health care services, procedures, and facilities according to evidence-based criteria or guidelines, and under the provisions of an applicable health insurance plan. Typically, UM addresses new clinical activities or inpatient admissions based on the analysis of a case.
UM criteria are medical guidelines which may be developed in house, acquired from a vendor, or acquired and adapted to suit local conditions. Two commonly used UM criteria frameworks are the McKesson InterQual criteria [23] and MCG (previously known as the Milliman Care Guidelines). [24]
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Milliman, formerly Milliman & Robertson, is an international actuarial and consulting firm based in Seattle, Washington. The company was founded in 1947, by Wendell Milliman and Stuart A. Robertson and operates 59 offices internationally, with over 3,000 employees. [citation needed] Milliman is owned and managed by approximately 350 principals. [1]
Inpatient care is the care of patients whose condition requires admission to a hospital. Progress in modern medicine and the advent of comprehensive out-patient clinics ensure that patients are only admitted to a hospital when they are extremely ill or have severe physical trauma .
Voluntary admissions may be the first alternative to involuntary commitment that comes to mind. But Heyrman said even with voluntary mental health admissions, a patient can be kept beyond their will.
Current and former Vitas employees said the company intentionally overuses continuous care and inpatient care services in order to pad Medicare bills. Continuous care is meant for patients in crisis situations, such as severe, uncontrollable pain, according to Medicare guidelines.
Spicy Chick-Fil-A Chick-n-Strips. For those who crave a kick of heat, Chick-fil-A’s Spicy Chick-n-Strips were a standout hit. Chicken breast strips seasoned with a spicy blend of peppers quickly ...