Physician Advisory Services
Medicare Advisor: Timely and Appropriate Conversion from Observation to Inpatient
Who we are
Medicare Advisor integrates with your Sound hospital medicine team to ensure that no Medicare fee-for- service patient is overlooked. We monitor these patients in real time to determine if they’re most appropriate for inpatient or observation based on medical necessity and the Centers for Medicare and Medicaid Services’ (CMS) two-midnight rule, with timely status recommendations before discharge.
Our physician advisors are experts in documentation and determining appropriate status to help you maintain compliance and maximize efficiency with timely decision-making for Medicare patients based on CMS-specific criteria.
How it works
Our integrated workflows with hospitalists identify Medicare fee-for-service patients admitted to the hospital (inpatient and observation) after the first midnight of their stay. When you’re able to do this, you’ll notice several significant changes, including:
- Recovering lost revenue from untimely decisions — specifically failing to admit to inpatient prior to a discharge order being written.
- Freeing up time lost to case management queries.
- Patients reporting a better overall experience.
- Length of stay (LOS) improvement for both observation patients and inpatients.
We seamlessly integrate with your hospital medicine program by validating the original admission order input by the hospitalist. And if you have a physician advisor, we work alongside them to make their lives a little bit easier by focusing our attention on Medicare patients who can sometimes slip through the cracks.
Benefits of Medicare Advisor
- No additional technology required; seamlessly integrates with your Sound Hospital Medicine program.
- An average hospital annual revenue increase of $700K.
- Fewer case management inquiries
- Improved regulatory compliance and decreased audit risk.
- A 36 percent average drop in observation discharges longer than two midnights, which results in LOS improvement for both inpatients and patients under observation.
TRANSFORMATIVE CHANGE: A snapshot of two hospitals
Partnering with physician advisors through our Medicare Advisor program can yield significant results. Our scope is highly specific, and our data demonstrates that when you have someone focused on this critical issue, you get the benefit of meaningful, measurable, and reproducible change.
Hospital A | East coast health system, 3 hospitals, 500 beds combined
OBS Rate 2+ MN Med FFS: 49% in 2022 to 25% in 2023
Approximate Annualized Revenue: $550,000 in 2023 to $1.3M in 2023
Hospital B | Midwest hospital, 2020 short-term acute beds
$312k first quarter approximate revenue
$1.2M approximate annualized revenue