The Expanding Role of the Physician Advisor in HCQM
Are you looking for online courses for recertification or striving for the Physician Advisor Sub-Specialty? Our newest online course will meet both of these needs.
The role of the physician advisor is evolving in today's health care systems. This course will describe the history of the physician advisor and the physician leadership roles that can be fulfilled throughout the care continuum including: transitions of care support, interdisciplinary team management and communication, the transition to ICD-10, determining patient status and level of care, Medicare appeals and medical necessity reviews, and many more facets impacting the quality of care patients receive.
At the conclusion of the course, attendees will be able to:
- List the areas of potential influence for the experienced and well-trained physician advisor.
- List and describe three classifications of the basic types of medical necessity reviews.
- Explain the advantages of the physician advisor and care manager Dyad leadership model.
- Explain the importance of the CMS Title 42 of the CFR as related to healthcare.
- Summarize the CMS requirements for Inpatient and Outpatient level of care.
- Describe the application of the Two-Midnight Rule as a requirement for inpatient level of care for Medicare beneficiaries.
- List the CMS Conditions of Participation requirements for issuing a Condition Code 44.
- Describe how the definition of observation services differs from inpatient status, both from the perspective of CMS and commercial payers.
- Outline the advantages to a well-organized multi-disciplinary approach to managing complex discharges.
- Identify and contrast several current pay for performance programs.
- Describe two established models for implementing an effective transitions of care discharge plan.
- List and describe the five main stages of the RAC Appeal process.
- Contrast the differences between Palliative Care, End of Life Care, and Hospice Care.
- Outline the guidelines governing the CDI Query process.
- Discuss the nuances of ICD-10 coding, risk factor, and condition categories.
- Outline the tools and building blocks of an effective organization.
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