Physician Advisory Solutions

A team of nurses use screening criteria to ensure compliance of the admission status order and Medicare’s condition of participation. We identify and mitigate cases at risk for denial across all payers, supporting or supplementing your clinical staff so they can focus on delivering high-quality care.

Navigate the intricacies of complex and ambiguous Medicare regulations so you can bill appropriately for the care you deliver. Our highly trained, licensed physicians review the documentation on concurrent and post-discharge hospital stays to support compliant admission status. We prepare a fully written consult and then discuss the recommendation and supportive reasoning with your case manager and physician to enhance documentation and prevent denials.

Our concurrent denials management service provides experienced physician advisors to discuss commercial denials with the payer on your behalf during a patient’s hospital stay. R1 physicians and teams review all pertinent records and arrange a phone consultation with the denying medical director. Our system automatically informs case managers when insurance companies have been contacted and updates the outcome to help analyze payer behavior.