Soon Accretive Health Physician Advisory Service will begin partnering with and supporting Seton Healthcare Hospitals, Case Management and Physicians in admission status reviews for medical necessity and appeals management. The partnership will help to ensure hospital medical necessity compliance. Over the coming year, Accretive’s Physician Advisors will be working closely with our case management team and our Physicians as needed to help ensure regulatory compliance. This letter is 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 resources 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 Observational Services
- Inpatient Admission
How will cases be referred to Accretive?
Case Management staff will refer cases to Accretive physician advisors via a web portal. Accretive physicians are available 6am-2am 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 and via EMR access.
How will this affect me and the care of my patients?
If a case does not meet commercial criteria for the ordered status, the case may be referred to AccretivePAS for further review. Upon completion of a case review, a status is recommended. If there is a change in status from what was ordered, Accretive physicians may reach out to our physicians, depending on the agreement, to discuss cases in which there is not agreement on the status order. 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 AccretivePAS review is only a recommendation based on the documentation provided
- 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 in accordance with applicable federal and state law, and hospital policies.
Over the coming weeks, Accretive will be rolling out this service with our project team. We anticipate that all hospitals will be implemented by January 9, 2017.
If you have questions now or in the coming days - please reach out to Stephen Ricks/Director of Case Management at 512-324-7000, ext. 77059 with questions regarding our partnership with Accretive Health.