EHR Physician Advisors have successfully performed more than 9 million medical necessity reviews, conducted hundreds of audits at hospital facilities, and successfully identified and reversed thousands of inappropriate medical necessity denials, concurrently and retrospectively, at all levels of appeal.
Hospitals have often struggled to achieve a proactive, compliant, concurrent medical necessity review and certification process. The reason is simple compliance cannot be achieved through a part-time or "9-5" program. As a result, EHR Physician Advisors are available seven days a week, 365 days a year.
EHR has a dedicated team of research clinicians and attorneys who are devoted to preparing evidence-based, risk stratification data to be used by EHR Physician Advisors. This clinical and regulatory research, combined with the EHR's database of more than 9 million medical necessity reviews, delivery through EHRic's workflow engine, and solid quality assurance process represents EHR Logic.
EHR Physician Advisors work in teams and are supported by nurse case manager and administrative team members. Each team of EHR Physician Advisors works with a set group of EHR clients, allowing for strong relationship development.
A key component of the EHR review process involves EHR Physician Advisors speaking directly with attending physicians. This collaboration helps EHR Physician Advisors gain greater understanding of the physician's intent, and also provides a peer-to-peer educational opportunity.
EHR Compliance Protection
EHR is confident in its process and provides protection to hospitals using certain concurrent solutions through the EHR Compliance Protection. In many cases, if a client receives a medical necessity denial for a case that was reviewed by EHR, EHR will manage the appeal on behalf of the hospital.
EHR Physician Advisors' recommended admission determinations are audited monthly for consistency and utilization of EHR Logic. EHR utilizes a real-time quality assurance methodology to ensure that any recommended determination that results in an order change is reviewed by a second EHR physician.
EHR Physician Advisors provide validated, physician-signed documentation, certifying appropriate bed status, which is placed directly on each patient chart. EHR review and certification is based strictly on utilization management criteria and CMS rules and regulations.
Every EHR case review is managed by EHRic, EHR Information Center, a proprietary data and workflow management system that supports efficient Physician Advisor activity. EHRic ensures that case reviews follow a consistent process a mission-critical requirement of a compliance program.
In addition to customized, onsite education sessions that take place during implementation and then semi-annually, EHR offers its quarterly Accelerated Compliance Training (ACT) Series via audio conference. EHR also hosts regional half-day education sessions for many clients throughout the year.