Physician Advisory Services

Our team of Physician Advisors is available to consult with attending physicians and staff on various aspects of a patient's stay that could impact receipt of the appropriate reimbursement. We have numerous practicing physicians on our staff assisted by experienced RNs who understand the complex issues that impact what hospitals are paid.

Services Include:

• Level of Care Consulting
• Continued Stay Management
• Documentation Consultation

As Recovery Audit Contractors (RACs) continue to make an impact on hospitals across the country, MedManagement can assist you to prepare for and prevent RAC appeals.

Once a RAC determines that a hospital or other practice has been overpaid, said facilities are required to  repay Medicare and/or they can file a RAC recoupment appeal. The RAC appeal process is a lot more complex and time consuming than the concurrent process, and may involve lawyers, statisticians, and other experts, making it costly as well.

To avoid the RAC appeals process or other concerns, hospitals, clinics and private practices should develop a strategy that includes the creation of policies and procedures for proper clinical documentation. This not only ensures you receive the appropriate reimbursement for services, but can assist with RAC appeals if you are audited.

Our Physician Advisors are trained to review medical records and apply medical judgment to the determination of inpatient vs. outpatient (observation services) level of care. They assist hospitals, clinics, and private practices in providing documentation in the medical record to support the level of care that is billed – a proactive approach to RAC audits that supports a strong compliance program and protects your hospital from both financial and legal difficulties.

A large number of improper Medicare payments are a result of incorrect coding. Our Physician Advisors and Clinical Documentation Specialists also follow up with undocumented or under-documented clinical procedures and ensure documentation and coding is compliant with the proper policies. Their collaborative approach with attending physicians advances the goal to document appropriate level of care and therefore assists the hospital in the event of an RAC appeals case, saving hospital staff time and money.

For more information on preventing RAC appeals, please contact us today.