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Also Medicare percentage having provider PHP needs concurrent review to possess continued publicity beyond first qualification episodes. Aetna, UHC Optum, and you may Magellan all want concurrent opinion to own IOP and you may PHP. Apps one to prepare for concurrent opinion which have structured scientific information and you may most recent ASAM otherwise LOCUS recommendations score went on authorizations. Concurrent opinion articles are usually owed twenty-four in order to 72 period before the present day agreement expires. The preferred recharging mistake within the IOP and PHP is twice-billing the for each and every-diem while the individual lesson codes, and that provides instantaneous CO-97 denials. Inside a per-diem time, certain qualities can be billed by themselves (pass-because of features) versus breaking brand new for every single-diem bundling.
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Brand new CY 2025 latest rule centered permanent telehealth exposure to possess behavioural wellness IOP and you will PHP properties for Medicare beneficiaries. Common when concurrent feedback try skipped and also the auth ends. Most typical whenever ASAM, LOCUS, or payer-specific severity standards are not noted during the admission and also at concurrent remark durations. Generate concurrent review with the IOP and you will PHP logical workflow since a continual activity, maybe not a reactive procedure due to an enthusiastic auth termination aware.
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