This education consists of case presentations that address the physician advisor workflow regarding reviewing cases for appropriate status (Inpatient vs Outpatient) while applying the rules and regulations as set forth by CMS, State authorities and the various insurance plans. In addition, cases focus on the decision to proceed with an appeal of a denial by a payer.

Course Director:
Stephen Crouch, MD; Medical Director, Integrated Care Management, Advocate Health-Midwest
Rebecca Severe, MD; Medical Director, Care Management, Advocate Health-Midwest

Overall Objectives:

1. Summarize current rules and regulations in order to design best-practice approaches to provide a recommendation for the appropriate patient class for the admission and decide on proceeding with a peer to peer discussions and written appeals
2. Apply evidence-based methods and current practice guidelines to provide a recommendation for the appropriate patient class for the admission and decide on proceeding with a peer to peer discussions and written appeals

Target Audience:  
This activity is designed for Physician advisors who are all licensed MDs or DOs.

Accreditation Statement

In support of improving patient care, Advocate Health is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Credit Statement

American Medical Association (AMA) 
Advocate Health designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.