iUTMB Home Page iUTMB    Published Monday, June 24, 2013, 2:00 PM

UTMB Physician Forums for Medical Necessity Compliance Management

Hosted by UTMB Physician Leadership and the Office of Institutional Compliance

Continuous management of resource utilization is a challenge we all face in today’s dynamic healthcare environment.  This is being compounded by increased pressure across the country from governmental and commercial payors regarding concerns about extended lengths of stay, payment denials for avoidable days, appropriate admission status and compliance with Conditions of Participation.  The only way to effectively manage these issues is through a comprehensive approach that focuses on improving medical management, coordination of care, accuracy of patient status from point of entry, and communication among all members of the care delivery team.
 
Care Management is the first line of defense, but their efforts need to be supported by experienced physicians who can both facilitate solutions for faculty physicians and work with the payors on justifying appropriate payments for services rendered to our patients.  We will be implementing such a program in collaboration with Executive Health Resources® (EHR), a physician-operated organization which provides outsourced medical-necessity compliance and denials-management solutions to acute-care hospitals.
 
A primary objective of the program is to ensure compliance with medical-necessity regulatory guidelines.  The program places a strong emphasis on interaction with attending physicians in a positive and collaborative manner, as your intimate clinical knowledge of the patient provides critical information to the EHR Physician Advisors.  Additional information about EHR and the services they provide can be found at www.ehrdocs.com.
 
We will be providing additional information and training throughout the institution at various faculty and leadership meetings.  Additionally, three forums for all faculty with admitting privileges and residents will be held on the following dates (No registration required.):
 
·       June 27:  Noon - 1 p.m., Levin Hall Main Auditorium
·       June 27:  6 - 7 p.m., Levin Hall North Auditorium
·       July 9:     7 - 8 a.m., Clinical Science Building, 3rd Floor Auditorium 
 
These sessions will also be available via webcast at http://129.109.152.33/comp.sdp.  For technical support over the phone before or during the LIVE broadcast please call the IS Control Room at 409.747.9037.
 
All other questions regarding these forums should be directed to compliance.office@utmb.edu or 409.747.8700.



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