Physician Advisors in the Expedited Appeal Role

sommer_slavin@urmc.rochester.edusommer_slavin@urmc.rochester.edu
edited May 2016 in Physician Advisors
We had a great question arise from one of our Nurse Leaders that I don't know the answer to. Hoping other systems have come across this question and can share what they do or do not do in their practice?

There are often times when there is a need for an MD to MD conversation between hospital and payer so that continued Inpatient Authorization is secured. At times, Attending Physicians are willing to do these calls but we run into scheduling issues when the commercial Payers are dictating what time slots are available for calls. My question would be, if one of our Physician Advisors has reviewed and weighed in on the admission, can they advocate for the case in the MD to MD call?

Sommer Slavin, RN, MS, MBA
Operations Manager
Utilization Management at Strong Memorial Hospital
Work (585) 276-5265
Pager (585) 275-2222 PIC 3226

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Comments

  • cari.merlina@uchealth.orgcari.merlina@uchealth.org
    edited May 2016
    Case Mgmt has had to ask our CMO (who basically acts as our physician advisor) to make the peer-peer call to Cigna, because the surgeon could/would not. It worked just fine.
    c

    Best Regards,

    Cari Merlina RN, BSN
    Clinical Documentation Improvement Specialist
    Revenue Cycle
    Yampa Valley Medical Center
    1024 Central Park Dr
    Steamboat Springs, CO 80487
    p.970.871.2425
    f.970.875.2796
    Cari.merlina@yvmc.org
    [yvmc]







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