Physician Advisors Utilize Risk Prediction and Stratification Models to Improve Compliance and Secure Appropriate Reimbursement
Physician advisory teams play an important role in helping hospitals improve compliance and secure appropriate reimbursement. Utilizing risk stratification tools, physician advisors appropriately identify instances when a patient’s clinical presentation, comorbidities, and/or risk of complications may dictate and support an inpatient admission.
Hospitals have to decide how to appropriately classify patients in compliance with rules and regulations to secure proper reimbursement. They face challenges with the constantly changing regulatory environment. Also, if they misclassify a patient’s level of care status, they may miss significant compliant revenue or may be at risk for subsequent denials.
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