Taming Medical Necessity Challenges With Physician Advisor Programs

In an era of value-based care, providing documentation of medical necessity and using evidence-based standards of care are essential to reduce waste while ensuring providers are appropriately reimbursed. However, the single most common cause of improper payments is lack of clinical documentation, especially when supporting medical necessity, according to CMS. When clinical documentation fails to meet a commercial payer's standards, claim denials can be labor-intensive and costly to appeal. Although clinical documentation presents ample opportunity for improvement at most healthcare organizations, physicians often overlook or don't understand the importance of patient status determination and clinical documentation in both patient care and financial performance, further complicating the issue.

Download this whitepaper to learn:

• Challenges associated with determining patient status and medical necessity
• Benefits to implementing a physician advisor program
• How to start a successful physician advisor program

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