External Physician Advisor Services

Soon Accretive Health Physician Advisory Service will begin partnering with and supporting The Medical Center of Aurora case management, as well as physicians in medical necessity classification decisions and appeals management.  The partnership will help to ensure hospital medical necessity compliance and revenue protection.  Over the coming year, Accretive’s Physician Advisors will work closely with our case management team and our physicians to help ensure regulatory compliance.  We wish to provide you with some information regarding the service and engagement.
 
What are the benefits to having Accretive Physician Advisory Services?
 
The benefits of the Physician Advisory Services include expertise in CMS regulatory guides, consistently applied process improving compliance, direct communication with the physician advisor and additional resource for RAC/MAC/ Medicare HMO/ Commercial Payor denial defense.
 
The Physician Advisory Services offers trained physician advisors medical necessity specialists to assist in patient status reviews and to make recommendations for:
•              Outpatient
•              Outpatient Observational Services
•              Inpatient Admission
 
How will cases be referred to Accretive?
 
Case Management staff will refer cases to Accretive physician advisors via web portal.  Accretive physicians are available 8 a.m. – 12 a.m. CST for direct contact and review of cases submitted into the portal. 
 
Accretive physician advisors will have access to clinical information as it is provided by the case management staff. 
 
How will this affect me and the care of my patients?
 
Upon completion of a case review, a status is recommended.  If there is a change in status from what was submitted, Accretive will reach out to the appropriate case manager or physician, depending on the agreement, to discuss the recommendation.  Case managers may be contacting the treating physicians for clarification of plan of care, or to relay a recommendation from an Accretive physician.
 
It is important to keep in mind that:

• The final, updated order must be written by the treating or attending physician. 
• In order to implement the recommendation, it may be necessary for you to change the admission classification status. 
• Whether or not to make such a change is a decision to be made only by the appropriately qualified provider, and in accordance with applicable federal and state law, and hospital policies.

We do not anticipate physicians to be significantly affected by this new service available to the hospital.  If you have questions now or in the coming days please contact Laura Bacak, director of Case Management at 303-695-2612.