Utilization Review Management Specialist Essentials 101

001286f3-ad68-4ba7-94a2-357c155a7e2d.jpgA vital component to the bottom line of any CD/SA treatment center, facility or program is the Utilization Review Department. It is the lifeblood of the company as it gets the authorization from insurance companies for reimbursements and a revenue stream for the maintenance of the financial security and the growth of the company, its employees’ wages and general well-being of the program in the recovery community. In teaming up with The Addictions Academy this course’s main objective is to fulfill an often requested service by the recovery industry, especially treatment centers and programs, and to offer some basic fundamentals for the delicate Utilization Review process which allows treatment programs, through their UR management specialists, to get the most reimbursements for the billing codes for CD/SA by the treatment facilities and, thus, allow for the fiscal sustaining and growth of a facility. This 3 1/2 hour course will enlighten the novice to understand the UR process, refresh and improve upon the education and maintenance of those seasoned in UR and shed light on some advanced features of the UR process with regard to peer to peer reviews and appeals!

 

What will you, the participant, get from such a course?

  • Definitions and Goals of the Utilization Review Process.
  • UR Precertification Process Steps Illustrated.
  • Pre-Certification Assessment Forms Reviewed and Illustrated.
  • Taking what you need from a comprehensive intake for the initial Pre-Certification call.
  • What questions are typically asked in the initial Pre-Cert will be examined and pearls for rebuttals discussed.
  • How to organize your presentation and What is the Axis(I-V)?
  • Learn tips for presentation of information to insurance carriers care managers.
  • Learn about the ASAM criteria and ASAMS Dimensional Criteria and their significance in CD/SA industry.
  • DSM 5 diagnosis will be examined and discussed.
  • Basic HCPCS coding and Revenue codes will be illustrated and discussed for the different levels of care.
  • Discussion of the Medical Necessity Disclaimer of Insurance Companies for Coverage of Treatment Services.
  • Concurrent or Continued Stay Reviews and ASAMS Dimensional Criteria will be examined and illustrated with discussion.
  • A detailed discussion will look at Therapist Auditing Notes instrumental to the UR specialist to allow for proper concurrent reviews with client care managers.
  • Advanced Topics will be discussed, including Peer to Peer Reviews and Appeals Process.