Medical Necessity Compliance Management|
Physician Certification Statement Review
Continued Stay Review
Cardiology/Vascular Procedure Review
Inpatient Rehabilitation (Post-Admission Review)
EHR's Real-time Medicare & Medicaid Medical Necessity Certification and Clinical Compliance Management solution is delivered through expertly trained Physician Advisors. EHR Physician Advisor teams, trained in Medicare and Medicaid rules and regulations pertaining to observation and inpatient status, provide the required secondary, concurrent physician review of Medicare/Medicaid observation status cases and inpatient admissions that do not meet case management's medical necessity screening criteria.
In addition, EHR has developed specialized products that address cardiology procedure review and certification and readmission review and certification, as many high-cost cardiology procedures and costly readmissions have been targets of increased scrutiny by retrospective government audit programs. Each of these programs can be contracted as a stand-alone solution or as part of EHR's comprehensive Medicare and Medicaid Medical Necessity Certification & Clinical Compliance Management program.
EHR's concurrent review process is strengthened by EHR Logic, the proprietary methodology used by EHR to classify cases by clinical groups and DRGs, to develop extensive evidence-based research by clinical group, to train the EHR Physician Advisor teams on the content and how to use it, and to build it into the EHRic system to allow for real-time access to support the EHR Physician Advisors during case review. The EHR Logic workflow also includes extensive quality assurance practices executed by various internal EHR teams.
Download "Understanding CY 2016 OPPS FAQs" to get the answers to the questions you may have to ensure your hospital withstands auditor scrutiny given CMS' regulatory changes.
Find out what you need to ask to assist in evaluating current medical necessity admission review programs and provide a checklist for ongoing evaluation of program effectiveness with our "Evaluating Questions for Admission Review Programs."
Download "Recommended Admission Status Workflow" to follow the proper steps needed to ensure proper patient status if your patient is expected to stay in the hospital overnight.
Make sure you use the "OPPS Change Scorecard" for the important metrics to consider when determining patient status.
Contact EHR to learn more about its Concurrent Governmental Payor Clinical Medical Necessity Compliance solutions and EHR Logic.