Revenue Cycle Management

We have a diverse group of advisors with a vast knowledge of CMS, JAHCO, and Payor guidelines. We hold positions and membership in:

• American College of Physician Advisors, (ACPA)

• Association of Clinical Documentation Integrity Specialists (ACDIS)

• American Case Management Association (ACMA)

• American Board of Quality Assurance and Utilization Review Physicians. (ABQAURP)

Physician support is the crux of our Enhanced Physician Advisor Model. This model serves to foster collegiality, respect, and engagement amongst the Physicians, CDI, UM, and CM teams. This collaboration protects patients and health systems to be fairly credited with quality metrics and reimbursed appropriately for care delivered.

Our team of physician advisors are medical doctors with active patient care experience who have undergone extensive training to understand the ins and outs of CMS compliance, Quality, Utilization Review, Clinical Documentation Improvement, and the complex interplay among competing initiatives in these spaces. This model serves to promote and support UM, CM, CDI teams to provide a superior level of functioning in a team based approach maximizing knowledge from each division.

As healthcare moves towards outcome based payment systems, risk contract arrangements are using new payment methodologies based upon patient complexity strongly dependent on clinical documentation (e.g. VBP, Hierarchical Condition Categories). Failure to fully document the full clinical picture of lives covered damages an organization’s standing in the risk pool.

Additionally, publicly reported outcomes related to complications, mortality and value based purchasing metrics have the likelihood of being positively impacted. These metrics serve to enhance the public reputation of the provider (Health Care Entities and Physicians) as well as the avoidance of significant penalties and possibility of financial rewards.

We believe in building up investment and engagement with providers and administrative partners across each entity. A good team depends on how well you interact with colleagues, and being a strong part of the overall program, being transparent and accessible, problem-solvers. Hanover Physician Advisors leverages each entity for synergy and success together.