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The Physician Advisor Handbook
Free for ACPA Members

Read the ACPA Physician Advisor Handbook for free online as a benefit of your ACPA Membership!

The American College of Physician Advisors is pleased to announce the publication of "The Physician Advisor Handbook", co-authored by Dr. Pooja Nagpal and Dr. Ven Mothkur and edited by Dr. Daniel Zirkman and Dr. Steve Meyerson. This handbook offers a comprehensive review of the multiple areas of influence and levels of expertise that are within the scope of a well-versed physician advisor as a valued member of the hospital's leadership team and is now available for purchase at Amazon Books.

Current ACPA members can read an online version of the book free of charge.

Click Here.

This is a must read for physician advisors at any level of experience and is a useful tool to share with other members of your organization's leadership including care managers, utilization team members, compliance officers, quality and patient safety experts and the entire administrative leadership team.

Online Course


Physician Advisor Program Metrics

Elizabeth Lamkin, MHA, ACHE, ACPA

June 2017

The success of Physician Advisor (PA) programs in quality improvement, margin protection and regulatory risk reduction has led to the identification of measureable metrics to evaluate and monitor a PA program. This article will provide an overview and examples of how to measure success and how to use metrics to sustain improvements.

Overview

Hospital margins are shrinking and the regulatory environment has intensified leaving hospitals struggling to maintain positive bottom lines and meet regulatory requirements.  To survive, hospitals are working to improve rapidly systems to reduce risk of denials and improve billing compliance.

The role of a PA is well recognized as a clinical resource to improve margins and compliance. Successful hospitals also focus on the role of the PA in the revenue cycle to ensure revenue integrity. Figure 1. The PA role can integrate activities across hospital functions, thus linking finance to clinical staff. Resources in Care Management and Physician Advisors shift the focus from back end rework to front end revenue integrity to prevent errors. The front-end engagement with physicians and clinical staff provides concurrent oversight of compliance and reduces denials from medical necessity and documentation errors. 

 

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ACPA Response to CMS Request for Comment

Inpatient Prospective Payment System Proposed Rule, FY 2018

CMS-1655-P

June 12, 2017

In the 2017 Inpatient Prospective Payment System (IPPS) proposed rule (CMS-1655-P) the Centers for Medicare and Medicaid Services (CMS) requested input on ideas that would make regulations less burdensome and more transparent. We appreciate this effort. Our “all inpatient” proposal is aligned with these goals.

We are proposing a change in Medicare hospital admission regulations that would eliminate outpatient observation and treat as inpatients all patients who require hospital level care.

The two-midnight rule, which was implemented on October 1, 2013, was supposed to create a “bright line” between inpatient and outpatient status. It has failed to do this, as evidenced by the high level of denials for one-midnight admissions in the MAC “probe and educate “program and the subsequent one-midnight reviews by the QIOs - despite hospitals having expending immense resources in their attempt to determine patient status accurately. The high levels of denials and recoupments with subsequent appeals have caused such a severe overload that the appeals system has experienced a massive backlog: Some 700,000 cases remain in the queue with a 500+ day wait for adjudication by administrative law judges that is supposed to be limited to 90 days by statute. A federal court has instructed CMS to clean up the mess.

 

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Response to RFI for 2017 MAO Transformation Ideas

Response to RFI for 2017 MAO Transformation Ideas
The Honorable
Thomas E. Price, M.D.
Secretary of Health and Human Services
Hubert H. Humphrey Building
200 Independence Avenue, S.W.
Washington, D.C. 20201

April 24, 2017

Dear Secretary Price and CMS Administrator Verma:

The American College of Physician Advisors (ACPA) appreciates the opportunity to respond to your RFI soliciting ideas to better achieve transparency, flexibility, program simplification, and innovation in the administration of Medicare Part C. The majority of ACPA members are physicians who are professionals with specialization in quality, utilization review, and utilization management for hospital-based providers. Our members interact with Medicare Advantage Organizations (MAOs) on a daily basis, thus gaining detailed 360-degree knowledge and experience from the point of care. We hope that the ACPA recommendations offered here will be useful to help achieve greater standardization, transparency, and effectiveness in the Part C program for the benefit of all stakeholders.

Medicare Part C offers several potential advantages to Medicare beneficiaries and to the Centers for Medicare and Medicaid Services (CMS.) MAOs are already required to provide all of the benefits of traditional Medicare.

 

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