Physician Advisory Services
Incorrect patient status costs hospitals millions of dollars. Our on-site and remote physician advisors address the root cause for missed reimbursement by tightly integrating with the hospital case management team and medical staff to ensure appropriate level of care and clinical documentation throughout the patient stay.
- 40% improvement in status accuracy
- 7%-10% reduction in denials
- 20% improvement in peer-to-peer overturn rate
What our leaders say
Chris Shearer, MD
What our leaders say
Physician Advisory Services
Our Holistic Approach to Physician Advisory Services
Accurate Initial Status Determinations
Getting status right is at the core of our physician advisory services. Most hospitalists are not trained on the specific payer guidelines and regulations required to appropriately document medical necessity. As a result, patients tend to stay longer in observation, receive the same level of care, and impact a hospital’s length of stay. Our expert physician advisors review the patient’s severity of illness, provide proper documentation feedback required to support the status, and may suggest a status change if needed.
- Admission status review
- Utilization management
Technology-Enabled Workflows & Platforms
Advisor Connect, Sound’s proprietary web-based case review platform, provides visibility throughout the entire case review process. The system allows for quality monitoring, case management workflow, MCG and Interqual access, and appeal letter reviews. It also includes a robust reporting pack.
Our AI technology continuously monitors clinical, payer, and demographic data and identifies patients that qualify for a physician advisor case review. By leveraging our proprietary technology, our programs take the guesswork out of the process and reduce the burden on case management.
Through AI and ADT/HL7 integration, our rules engine allows for high-risk cases to be auto trigged for a physician advisor review to quickly and confidently make informed bed status determinations and document criteria to assure reimbursement.
Peer-to-Peer, Denials & Appeals Management
Our advisors are experts at peer-to-peer reviews, and managing and appealing denials to ensure our hospital partners are getting paid appropriately for the care they provide. Not only are they trained on effective strategies for engaging payers, they also provide direct feedback on denial reasoning to help clinicians correct their documentation.
- 70% overturn rate at our remote programs
- 90% overturn rate for our onsite programs
If a written appeal is necessary, our team is ready to manage and appeal denials. Our physicians will review the denial letter and draft the letter to appeal it so that clinical teams can continue focusing on patient care.
Proven Processes to Enable Behavioral Change
Our physician advisory programs leverage 20 years of clinical performance management expertise and a continuous feedback look to help educate clinicians to make better-informed status determinations. Our program helps to influence physician behavior and case management workflows to improve status accuracy over time.
- Physician advisor training and education programs
- Regulatory expertise
- Clinical documentation improvement
- Length of stay improvement
What our partners say
Jeffrey Sugimoto, MD
Our Physician Advisory Solutions
Onsite Physician Advisory Programs
A true hospital partner who functions as an extension of the chief medical officer, while improving utilization management and performance improvement across departments.
Our onsite physician advisors offer an integrated leadership role to help improve workflow, documentation, and manage denials. In addition to providing timely and consistent responses to status determinations and denials, the MDAS works directly alongside clinicians, providing feedback, education, and one-to-one coaching. The MDAS attends multidisciplinary rounds, serves on (or chairs) the utilization management committee, and leads initiatives to improve documentation, throughput, and efficiency of care.
Hospitals with a Sound MDAS have seen more efficient high-quality care for patients, improved LOS and CMI, and fewer secondary reviews, denials, and the need for appeals management.
Remote Physician Advisory Programs
A trusted advisory solution, responding to clinicians in one hour on average.
Our remote physicians provide on-demand secondary case reviews at a low cost for hospital partners of all sizes. Unlike some other remote advisory services, our physicians directly review the medical record and craft customized statements for each case, addressing the key metrics that drive performance – including medical necessity, clinical documentation, compliance, coordination, and quality of care. Additionally, denial and appeals support may be provided remotely, including ALJ level appeals and hearings, retrospective coding denials, and litigation support.
Physician Advisor Support Services (PASS)
Training and education to hospital-employed Physician Advisors to get them up to speed quickly and maximize case reviews.
The Physician Advisor Support Services (PASS) program is built on Sound Physicians’ 20 years of experience training and educating physicians. The program provides specialized education, training, and mentorship for hospital-employed physician advisors to maximize existing in-house physician advisory programs.
- Learning modules from our proprietary education platform, Advisor Institute
- Live one-on-one training with our expert physician educators
- Bi-Annual Inter-rater reliability (IRR) assessments
- Mock case reviews with interactive feedback
- Up-to-date compliance information, such as the 2-midnight rule
- Scheduled expert physician advisor access for complex case reviews
“The PASS Program is exceptional! Without PASS, it would have taken me months longer to learn the topics and many more to apply them effectively. I was able to hone in on what I needed to know and quickly get up-to-speed to be an effective physician advisor.”
– Hospital Employed Physician Advisor
Sound’s AI technology, ASSURe, continuously monitors clinical, payer, and demographic data and identifies patients that qualify for specific attention (e.g., physician advisor case review). Our rules engine auto flags cases for review with a high likelihood for conversion to inpatient, improving revenue capture opportunities and streamlining the current complex and manual process. Sound physician advisors notify hospitalists or attending providers of status changes and can provide feedback to address root cause and prevent denials or rework downstream. By streamlining the process Sound improves efficiency which allowing more time to focus on patient care.
Advisor Connect is a proprietary technology platform developed to manage the entire case review process – from initial case submission through appeals management – and provides advanced data and analytics to our partner hospitals.
Advisor Institute is our proprietary learning management system (LMS) for physician advisors and hospital staff. Our education team, led by our clinical leadership, continually develops on-demand eLearning modules, knowledge checks, training material, recorded webinars, presentations, workflows, and other resources.