Utilization review forms the first line of defense for revenue sensitive cases for hospitals; physician advisors serve as the backbone and second line for cases requiring greater scrutiny or closer inspection. While undertaking a second-level review, a physician advisor (PA) brings to bear years of clinical experience and regulatory expertise – it is a highly skilled job and PAs are often in short supply. Typically, utilization review staff use one of two methods to determine if the case should be escalated to a physician advisor: their own clinical judgement or technology. While the former has been relied upon for years, technology is increasingly used to support physician advisors. And if the right technology is put in place, escalations to PAs should decrease, not increase. It’s not about casting a wider net – it’s about using technology as a double-layered approach: first, to ensure that the right cases are identified and reviewed by nurses up front, second, to ensure that only the right cases are escalated to PAs for review.


Source: Your Physician Advisor Escalations Should Be Going Down