Aerolib Healthcare Solutions – Physician Advisor Services Intake Form
Aerolib Healthcare Solutions – Physician Advisor Services Intake Form
Hospital Information
Hospital Name:
Address:
City, State, Zip:
Primary Contact Name:
Title:
Phone Number:
Email:
Total Number of Hospital Beds:
Intake Questions
1. Does the hospital currently have a Physician Advisor program?
Yes
No
2. How are physician advisor reviews currently conducted?
Internal hospital-employed advisors
External contracted advisors
No formal program in place
3. Primary challenges in your current program (Check all that apply):
Insufficient reviews
High overturn rates
Lack of weekend or after-hours UR
Unclear admission statuses
Delays in CC44/preop
Ineffective appeal handling
No analytics
Limited training
4. Interested Services (Check all that apply):
Comprehensive Reviews, P2P, Appeals
Weekend TeleUR
7 AM Preop / CC44 Reviews
9 PM ER Reviews
1-Click UR App
Aerolib LMS
Appeals & Denials Tool
Business Analytics
5. Monthly inpatient admissions:
<500
500–1,000
1,000–2,500
>2,500
6. Daily case reviews:
<10
10–20
20–40
>40
7. P2P support cases (%):
<10%
10–25%
25–50%
>50%
8. Weekly CC44 reviews:
<5
5–10
10–20
>20
9. Monthly appeals/denials handled:
<50
50–100
100–250
>250
12. Electronic Utilization Review System?
Yes
Specify:
No
13. EMR system:
Epic
Cerner
Meditech
Other
Specify:
14. Interested in demo of Appeals and Denials Tool?
Yes
No
16. Open to a 90-day pilot program?
Yes
No
17. Key goals for partnering with Aerolib (Check all that apply):
Improve admission decisions
Raise appeal overturns
Expand after-hours UR
Automate UR
Strengthen training
Gain analytics
18. Additional requirements or concerns:
Budget & Financial Considerations
15. Estimated annual budget:
< $100,000
$100,000 – $250,000
$250,000 – $500,000
$500,000 – $1,000,000
$1,000,000 – $1,500,000
$1,500,000 – $2,000,000
> $2,000,000
Regulatory Audits & Compliance
10. Audited in the past 12 months (RAC, MAC, etc.)?
Yes
No
Number of audits:
Types of audits:
Primary findings:
Corrective actions:
Fines?
Yes
Amount ($):
No
Repayments?
Yes
Amount ($):
No
Legal escalation?
Yes
Details:
No
Internal audits?
Monthly
Quarterly
Annually
N/A
Findings shared with execs?
Yes
No
HIPAA Breach Reporting & Compliance
11. HIPAA breach in the past 24 months?
Yes
No
Number of breaches:
Nature:
Patients affected:
Identified by:
Internal
External
Mitigation/notification:
Follow-up audits?
HIPAA training?
Yes
Frequency:
No
HIPAA officer?
Yes
Name:
No
DLP/Breach detection tools:
Risk assessment done?
Yes
Date:
No
CAP from HHS/OCR?
Yes
Details:
No
Submit