Inpatient Medical Necessity – Physician Advisor and Case Management Staffing
H&A understands the needs and demands that providers face when dealing with medical necessity issues. We identify opportunities for performance improvement while ensuring accurate, appropriate, and compliant reimbursement. H&A’s Physician Advisor and Case Management fees are transparent based on per-encounter or monthly/annual subscription rates. Our service is a viable, reliable, and cost-effective alternative for hospitals in need of inpatient medical necessity, physician advisor, and case management support.
Our Patient Status team works with your physicians and case managers to get it right, from patient presentation to claim submission, and everything in between. Meeting the demands of managing and executing inpatient and Observation status medical necessity is challenging. Our job is to help make it easier.
Physician Advisor Services/Admission Screening
Our experienced, board certified physicians understand the demands of hospitals in meeting RAC and other payer admission screening scrutiny. Our physician advisors are familiar with concurrent admission screening reviews using InterQual, Milliman, and evidence-based criteria. They perform retrospective appeals, outpatient pre-certifications, pre-existing condition determinations, RAC reviews, length of stay management, and physician education regarding documentation improvement and the latest CMS initiatives.
Medical Necessity/Case Management Services
Performed by experienced Case Management professionals, H&A provides both concurrent, real-time point of service medical necessity review of patients being admitted from the emergency department and directly from nursing homes, as well as retrospective admission screening review of inpatient and Observation status accounts. We use InterQual and other evidence-based screening criteria to determine the appropriate level of care.
For concurrent, real-time Case Management support, H&A resources are available any time, day or night. Physician advisors are available for second level review of those cases that fail medical necessity screening by our expert Case Management staff.
For retrospective, educational Case Management assessments, H&A reviews a sampling of inpatient and observation cases to ensure that admission criteria have been met. We review our findings with the client’s Case management team and provide education as determined by review outcomes.
For more information, give us a call at 949-715-9336.