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Versalus Health Blog

The Role of the Physician Advisor in the Observation Rate Conversation

By Jerilyn P. Morrissey, MD

As a Physician Advisor, I lost track of the number of times I was summoned to a meeting to address concerns about a facility’s Observation rate. So, before you are called to the next meeting to fix an Observation rate, let’s take a few minutes and understand what Observation is and when it should be used.

Medicare Advantage or Disadvantage?

OIG Raises Concerns About Service and Payment Denials Under Medicare Advantage Plans

By Jerilyn P. Morrissey, MD

According to CMS, almost 37% of all Medicare beneficiaries will enroll in Medicare Advantage plans in 2019. Even though Medicare Advantage enrollees have rights and protections under Medicare guidelines, from a provider point of view, the burden of managing these plans can be overwhelming.

Aligning Payor-Provider UR Practices – Proceed with Caution!

By Joseph R. Zebrowitz, MD

Over the last few years, there has been a trend toward automating the medical necessity UR screening process using software to extract clinical data and either apply commercial criteria or create an acuity score. The payer-provider relationship is a zero-sum game, a tug of war. Whoever pulls harder, works smarter and deploys the right resources will win – and make no mistake, when the payer wins, the hospital loses. It’s time to take an honest look at your payer performance!

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