Concurrent Medical Necessity Compliance Management
Concurrent Governmental Payor Clinical Medical Necessity Compliance
- Real-time Medicare and Medicaid Medical Necessity Certification & Clinical Compliance Management
- Inpatient & Observation Review & Certification
- Cardiology Procedure Review & Certification
- Readmission Review & Certification
- Continued Stay Review
EHR's Real-time Medicare & Medicaid Medical Necessity Certification and Clinical Compliance Management solution is delivered through expertly trained Physician Advisors. EHR Physician Advisor teams, trained in Medicare and Medicaid rules and regulations pertaining to observation and inpatient status, provide the required secondary, concurrent physician review of Medicare/Medicaid observation status cases and inpatient admissions that do not meet case management's medical necessity screening criteria.
In addition, EHR has developed specialized products that address cardiology procedure review and certification and readmission review and certification, as many high-cost cardiology procedures and costly readmissions have been targets of increased scrutiny by retrospective government audit programs. Each of these programs can be contracted as a stand-alone solution or as part of EHR's comprehensive Medicare and Medicaid Medical Necessity Certification & Clinical Compliance Management program.
EHR's concurrent review process is strengthened by EHR Logic™, the proprietary methodology used by EHR to classify cases by clinical groups and DRGs, to develop extensive evidence-based research by clinical group, to train the EHR Physician Advisor teams on the content and how to use it, and to build it into the EHRic system to allow for real-time access to support the EHR Physician Advisors during case review. The EHR Logic workflow also includes extensive quality assurance practices executed by various internal EHR teams.
Contact EHR to learn more about its Concurrent Governmental Payor Clinical Medical Necessity Compliance solutions and EHR Logic.
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