What is Utilization Review?
Utilization review is a critical evaluation process used by managed care providers to determine the appropriateness of the level of care requested. Managed care providers use this process to authorize the least restrictive level of care based on the medical necessity criteria. Managed care providers will only authorize the level of care deemed medically appropriate for the services rendered.
Why is utilization review important?
Behavioral health and medical facilities need a utilization review department because it is a crucial aspect in obtaining payment for services rendered. Utilization review is the starting point for successful financial gain for any behavioral health facility. Having a well-trained proficient utilization review department will increase profitability as well as increase the client’s length of stay. Without the support of a highly skilled utilization review department your profitability will be limited.
How can Key Solutions Consulting help you?
We specialize in clinical documentation specifically for utilization review for chemical dependency. We will complete comprehensive documentation trainings and clinical assessment evaluations to maximize the amount of authorizations obtained per client thus increasing your revenue. Our goal is to help treatment facilities increase revenue by improving their rate of authorizations through a better understanding of the required clinical documentation needed for medical necessity.
Our services include:
- Chart auditing based on medical necessity criteria
- Utilization Review Training
- Comprehensive instructor led clinical documentation training
What separates Key Solutions Consulting from other consultants?
We are licensed and have over 10 years of experience working in this industry, therefore, we’ll only provide you with the most up-to-date information regarding the trends in utilization review. We will hit the ground running and will provide the facility with quality service. Key Solutions is dedicated to quality and excellence, therefore, making the process transparent.