RCM tip of the day: Engage physician advisors to assist with real-time appeals

Hospitals should engage physician advisors when appealing claim denials for the benefit of the patient and organization, according to Theresa Brandon, managing director of Novia Strategies, a national healthcare consulting firm.

Ms. Brandon shared the following tip with Becker's Hospital Review: "It's essential to educate physicians on the importance of their role in serving as an advocate of their patients' financial resources, as well as the hospital's. The appropriate level of care is best advocated by undertaking a physician-to-physician review. When payers are reluctant to pay for a specific level of care or procedure, the hospital's physician advisor should engage the patient's specialty physician in a peer-to-peer review. This process ensures that critical, patient-specific information is known and documented."

Click here for more information about claim denials.

If you would like to share your RCM best practices, please email Kelly Gooch at kgooch@beckershealthcare.com to be featured in the "RCM tip of the day" series.



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