Case Management

Case management Q&A

Case Management Weekly, October 24, 2012

Q. What is the role of a physician advisor? 

A. Physician advisors work with and advise case managers with respect to utilization review and determining medical necessity. They can bridge the gap with medical staff, provide support for review, and co-chair the utilization review committee.  

The days of a physician being in total control of the admission and discharge process have long passed. Physician advisors can serve as a bridge to reluctant practitioners who insist that they are in control and explain the need to ensure proper admission and discharge of patients, which directly affects reimbursement. 

Editor’s note: This Q&A is adapted from Prevent Denials and Win Appeals: The Hospital Case Manager’s Guide to Revenue Integrity published by HCPro, Inc.

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