The Expanding Role of the Physician Advisor in HCQM

4.25 CME Credit

4.0 CE Credit

ABQAURP sub-specialty credits: Managed Care 4.25, Patient Safety/Risk Management 2.5, Case Management 4.25, Transitions of Care 2.5, Physician Advisor 4.25


The role of the physician advisor is evolving in today's health care systems. This course will describe the history of the physician advisor and the physician leadership roles that can be fulfilled throughout the care continuum including: transitions of care support, interdisciplinary team management and communication, the transition to ICD-10, determining patient status and level of care, Medicare appeals and medical necessity reviews, and many more facets impacting the quality of care patients receive.

At the conclusion of the activity, attendees will be able to:
  • List the areas of potential influence for the experienced and well-trained physician advisor
  • List and describe three classifications of the basic types of medical necessity reviews
  • Explain the advantages of the physician advisor and care manager Dyad leadership model
  • Explain the importance of the CMS Title 42 of the CFR as related to healthcare
  • Summarize the CMS requirements for Inpatient and Outpatient level of care
  • Describe the application of the Two-Midnight Rule as a requirement for inpatient level of care for Medicare beneficiaries
  • List the CMS Conditions of Participation requirements for issuing a Condition Code 44
  • Describe how the definition of observation services differs from inpatient status, both from the perspective of CMS and commercial payers
  • Outline the advantages to a well-organized multi-disciplinary approach to managing complex discharges
  • Identify and contrast several current pay for performance programs
  • Describe two established models for implementing an effective transitions of care discharge plan
  • List and describe the five main stages of the RAC Appeal process
  • Contrast the differences between Palliative Care, End of Life Care, and Hospice Care
  • Outline the guidelines governing the CDI Query process
  • Discuss the nuances of ICD-10 coding, risk factor, and condition categories
  • Outline the tools and building blocks of an effective organization
This course is intended for Physicians of all specialties, Nurses, and Other Health Care Professionals with appropriate CME credit and nursing contact hours offered for each profession.

The American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

ABQAURP designates this enduring material for a maximum of 4.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABQAURP is an approved provider of continuing education for nurses. This activity is designated for 4.0 contact hours through the Florida Board of Nursing, Provider # 50-94.

This program is approved for Category 2 credit by the American Osteopathic Association.

  All participants must achieve a final assessment score of at least seventy percent (70%) for recertification and continuing education credits. You have 60 days to complete the course after ordering. Please note: Exam candidates taking the Core Body of Knowledge and Diplomates renewing their certification may have less time to complete, as determined by deadlines imposed. This activity is valid from February 15, 2018 through February 14, 2021 (Original release date: November 1, 2015).

Please read the ABQAURP Privacy Policy and we suggest strongly that you read the System Requirements before continuing.

COURSE FEES: Diplomate $150.00      Member $170.00      Non-Member $210.00

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About The Authors
Members of the CME Committee, Planners, and Faculty have disclosed to ABQAURP any relevant financial relationships. No relevant financial relationships or conflicts of interest exist in regard to the content of this activity.



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