Physician Advisor & Case Management Comprehensive Education Support Program

Medicare and Medicaid Recovery Audit Contractor (RAC) recoupments, managed care denials and escalating medical necessity related length of stay issues are greatly impacting hospital bottom line revenues and driving related defensive expenses. In reaction, many hospitals are hiring Physician Advisors but a lack of formal training in addressing these challenges hinders effectiveness. Other providers are contracting with very costly third party physician advisory services to determine admission status with no end in sight to the increasing associated expenses.  To make matters worse, Case Managers are also being confronted with regulatory and medical management changes but have not had suitable education on how they apply to the case management role and patient throughput.

In response to industry needs, BESLER Consulting’s expert staff is offering a Physician Advisor and Case Management Education and Support Program (PACMan ESP) that will assist our clients in:

• Building a robust in-house Physician Advisory program
• Improving Physician Advisor effectiveness and determinations
• Establishing an efficient and effective Case Management model
• Ensuring appropriate patient status designation
• Reducing denials
• Decreasing lengths of stay
• Affirming revenue integrity and compliance

Our program is designed to identify your specific needs and present recommendations, provide the identified appropriate education and training, and make available on-going resource support. This Program incorporates the following components:

Assessment – BESLER Consulting will provide a one-day, on-site assessment of in-house Physician Advisory and Case Management Services in order to determine the resource, support and educational needs of your facility. Operational practices, including software tools, team coordination and the use of key performance metrics will also be evaluated.

Physician Advisor Education – Our Physician Advisor will provide a one-day training session (four hours at your site) to your Physician Advisors. This session provides your Physician Advisors with the guidance and tools necessary to make appropriate determinations based upon medical necessity. Training materials are tailored to meet your facility’s needs.

Case Management Education – BESLER Consultants will provide a one-day training session (six hours at your site) to your Case Management staff based upon the hospital-specific needs identified in the Assessment.  This session incorporates operational process improvements, Physician Advisor coordination, denial reduction techniques and revenue capture assurance practices.

Continuing Education/Support – BESLER Consultants will provide telephone support during the ninety-day period following the completion of the education sessions. Once the education sessions have been completed, this support will provide your hospital with a resource to assist in the support of workflow improvements and decision making processes.