Make your physician advisor your closest ally.
As the pressure increases for case managers to help ensure that hospitals comply with payer requirements and get paid appropriately, physician advisors can be a valuable ally. Physician advisors have clinical expertise as well as credibility with the physician staff, which gives them an advantage when it comes to educating physicians about patient status, documentation needs, patient throughput, and transitions in care. Case managers and their physician advisors should work together to ensure that everything in the patient record is correct up front so the hospital will avoid costly appeals when the claim is denied. Good physician advisors have the kind of personality that enables them to have difficult conversations as well as being well-respected by their colleagues, knowledgeable about admission criteria and reimbursement, accessible, approachable, articulate, and collaborative.
D019090:Case Management; D003299:Cooperative Behavior; D004469:Economics, Hospital; D019983:Guideline Adherence; D007349:Insurance, Health, Reimbursement; D010820:Physicians