Navigating through the intricacies of Medicare regulations and ICD-10 implementation is challenging enough for busy medical professionals. Now, the introduction of new health care policies as set by the federal government is making it even more difficult for healthcare providers and staff to give their patients the most thorough and accurate care. 

The reality is that our healthcare climate is shifting in a big way, and keeping up with changes to policies and regulations requires the kind of time and attention that clinical professionals simply do not have to spare. This is why the role of a physician advisor has become so essential to health care. Doctors who can assist their peers and other hospital personnel as liaisons are more essential than ever.

What Does a Physician Advisor Do?

Physician advisors are involved in many areas, including patient quality and safety, billing status determinations, clinical documentation, patient length of stay, utilization management, and appeals. A physician advisor’s typical day may consist of doing rounds with doctors in the morning, then meeting with case management teams for multidisciplinary rounds, all the while ensuring compliance and seeing that quality care is being provided and staff is communicating effectively. Physician advisors use their clinical skills daily, but they are not directly responsible for patient care.

Essentially, a physician advisor’s role in the current healthcare climate is to serve as a consultant who aids medical practitioners in determining the best way to comply with health regulations and policies to improve hospital operations while also providing enhanced patient care. The physician advisor is not only a help to physicians, but also nurses, case managers, and other medical personnel, serving as the intermediary between hospital clinical staff members and hospital administrators.

A physician advisor’s role can include:

• Educating staff on ICD-10 documentation requirements.
• Educating medical staff on the importance of complying with hospital policies and regulations, and explaining specific policy or regulation changes.
• Guiding documentation training for physicians individually or in group settings.
• Aiding hospital staff in preparing documentation for a Medicare compliance audit.
• Educating medical staff on coding changes or other procedural shifts.
• Bridging the gap between providing quality care and being influenced by a data-driven model.
• Assisting in the drafting of appeals for recovery audit contractor (RAC) denials.
• Mediating case conflicts between different hospital departments, teams, or individual staff members.

Tension can run high in a healthcare setting, for any number of reasons. A physician advisor, along with employing his or her clinical and administrative expertise, is also an educator, and must display strong interpersonal skills as they are called upon to be diplomatic, peace keepers, and adept at finessing relationships when a medical professional’s behavior needs to be altered.

Provident focuses on providing regulatory, operational, and financial optimization to help our clients thrive in the future of healthcare. Contact us to discuss how you can reach actionable outcomes with our risk management, documentation, and technological solutions.