PEPPER Reports

Hospitals have received or will be receiving their second round of PEPPER reports shortly. These reports contain the hospital

0 Comments

Physician Advisor Services – What’s Happening?

“Write a blog about what you are seeing with respect to physician advisors.” The concept of writing a blog about physician advisor activity seemed much like writing a term paper, until I realized that the blog was more like a conversation than like a treatise. Health care changes occur so rapidly that before a true “white paper” could be completed, the rules or interpretation of the rules will have changed. A short, succinct blog is a great way for us to share what is happening, our views of changes based on what our physician advisors are seeing and to encourage you to share what is happening in your world.

For those of you who aren’t familiar with MedManagement, we provide board certified physician advisors to assist providers with concurrent and retrospective medical necessity/documentation reviews. With Recovery Audit Contractors (RACs), Medicaid Integrity Contactors (MICs), and a variety of other alphabet soup auditors, casting their net broadly and seeking recoupments, health care facilities and other providers have to make certain that documentation is adequate to meet CMS and other payer criteria. Most of our clients have a great, committed staff, but there is a great need for independent physician advisors who are familiar with guidelines and criteria to address compliance issues. For Medicare and Medicaid patients particularly, physician advisors are necessary because compliance is dependent on demonstrating the “complex medical judgment” of physicians. In many cases, physician to physician education regarding documentation is the only way to make certain that documentation complies with requirements. Documentation and correct, timely orders are necessities, not luxuries! Even so, physicians are focused on caring for patients and only write down what they feel is necessary to care for the patient–not their thought processes. Our physician advisors help physicians understand what needs to be documented, and why. By sharing experiences and information we hope to make compliance less daunting, documentation easier, and your work place less frantic. A tall order for a little blog–but here we go!!!

0 Comments