Why Hospital Physicians Need Expert Physician Advisor Guidance 

Hospital physicians work in one of the most closely watched areas of healthcare. Insurance companies regularly review admission decisions, patient length of stay, and discharge timing, often using criteria that do not reflect the real-world complexity of patient care. 

In today’s everchanging healthcare environment, internal hospital resources are insufficient to meet growing payer demands. Hospital leadership is realizing the importance of incorporating expert external Physician Advisors to help protect clinical decisions, remain compliant, and reduce payer-related financial risks. 

The Reality of Inpatient Practice Under Payer Oversight 

Hospitalists make important decisions quickly, often with limited information and changing patient needs. Meanwhile, payers review these cases later, using strict and inflexible criteria. 

Common inpatient payer challenges include: 

• Patient status disputes (inpatient vs. observation) 
• Medical necessity denials for inpatient admissions 
• Payment reductions from DRG downgrades or unauthorized days 
• Retrospective audits disconnected from bedside realities

These challenges put pressure on clinical judgment often leaving hospital physicians feeling like they must defend their treatment decisions as they address the needs of an increasingly older and complex healthcare population. 

Why Internal Resources Are Often Not Enough 

Many hospitals depend on internal utilization review or case management teams. While these teams are helpful, they often face limits such as: 

• Limited physician-level payer expertise 
• High patient volume and staffing constraints 
• Lack of authority in payer escalation pathways 
• Reactive rather than strategic denial management 

Without Physician Advisor-level expertise, hospital hospitals may fail to realize earned revenue for medical necessity decisions based on physician judgment.  

The Critical Role of Physician Advisors in Inpatient Care 

Expert Physician Advisors offer clinical credibility along with strong knowledge of utilization management, payer policies, and regulatory rules. Their job is not to second guess patient status orders, but to help explain clinical complexity in a way payers recognize as medically necessary. 

Expert Physician Advisors provide: 

• Real-time guidance to utilization review staff on inpatient admission decisions
• Credible defense of medical necessity decisions during concurrent payer reviews
• Documentation strategies aligned with inpatient medical necessity criteria
• Physician-to-physician advocacy during escalations and appeals
• Clinical bandwidth that allows hospital physicians to remain at the bedside

For hospitals, this guidance helps reduce uncertainty and protects their earned revenue from unfair payer challenges. 

Why External Physician Advisor Expertise Matters 

External Physician Advisors bring objectivity and a deep understanding of payer rules that internal teams may not have. They see payer practices across many hospitals, regions, and contracts. They often have relationships with payer physician advisors  

This external perspective allows Physician Advisors to: 

• Identify payer trends and emerging denial tactics
• Apply best practices across inpatient settings
• Provide consistent, defensible guidance independent of local pressure
• Strengthen hospital positioning during disputes and audits

This leads to fewer surprises and better support when payer issues come up. 

How Brundage Group Supports Physicians and Hospitalists 

Brundage Group provides expert Physician Advisor guidance tailored for hospital settings. Our Physician Advisors work with hospitalists, utilization management, and revenue cycle teams to support care decisions at every stage of payer review. 

Brundage Group’s Physician Advisor services include: 

• Inpatient admission and medical necessity guidance 
• Concurrent review and payer escalation support 
• Denial prevention and appeal strategy 
• Feedback to providers to strengthen their understanding of medical necessity 

With external Physician Advisor expertise, Brundage Group helps hospital physicians focus on patient care and makes sure patient status decisions are well supported and defended. 

Physician Advisor Support as Clinical Protection 

For hospital physicians, Physician Advisors act as an important layer of protection. They help maintain clinical independence, reduce administrative hassles, and ensure payer demands do not affect patient care. 

Hospitals that leverage expert external Physician Advisors experience: 

• Reduced inpatient denials and patient status downgrades 
• Improved alignment between clinical care and payer criteria 
• Less administrative burden on hospitalists 
• Greater financial and operational stability 

In today’s inpatient environment, payer oversight is not going away; in fact, it is increasing. Hospitalists and utilization management teams should not have to handle this complexity on their own. 

Expert external Physician Advisor guidance gives the experience, perspective, and support needed to handle payer scrutiny and keep clinical standards high.