We specialize in clinical documentation specifically for utilization review for chemical dependency. We also provide complete comprehensive documentation training and clinical assessment evaluations.
Utilization review is an art! UR Reps must have the ability to take a sentence and create a story. Therapist must have the ability to obtain vital information and document appropriately. Nurses must have the ability to clearly document the symptoms and medical concerns. And doctors must have the ability to appropriately prescribe medications and document accordingly. All 3 departments are included because they play a vital role in obtaining authorizations.
The first step in securing authorizations is knowing what clinical documentation is needed for each level of care. By knowing what documentation is needed for each level of care you will have a better chance at securing authorizations thus increasing your revenue.
Now let’s break this down a little further by individual roles:
Your first point of contact when the client comes in for treatment will be your intake specialist. This is the person who completes your admission assessment for the initial authorization. Does your intake specialist have the ability to make the client feel comfortable enough to share their complete life story? You must remember the more information you have initially the better your chances are to obtain authorizations. If the specialist rush through the assessment, then there’s a chance there could be pertinent information missing or you may not have enough information to make an appropriate rebuttal.
Therapist documentation play a vital role in obtaining authorizations because they have face to face contact with the clients every day, if not most days. Therapists interacts with the clients and documents how the client is progressing throughout treatment. Depending on what clinical documentation is written in the charts will determine if the client will obtain authorizations or if the case will be sent for a peer review. A big misconception is that people say that therapists don’t know how to write, when in reality the therapist are excellent writers but don’t understand what clinical documentation is required for utilization review.
Nursing documentation play a vital role in obtaining authorizations especially for higher levels of care such as detoxification and residential. The nursing notes are imperative when seeking authorizations for higher levels of care because depending on what clinical is documented it can either make or break the case. Knowing key words and phrases will help build the case and provide clarity as to why the client is appropriate for the level of care requested.
MD documentation plays a vital role in obtaining authorizations because they provide the medications and evaluations for the clients. Doctors are intelligent individuals who are very knowledgeable about a lot of things, however, sometimes the documentation can lack what the UR rep needs when requesting authorizations for continued stay. After working in this industry for several years we’ve seen great documentation presented by MD’s as well as mediocre documentation. The goal is to make sure the documentation has useful information that will help secure authorizations with no questions asked.
Utilization Reviewers play a vital role in obtaining authorizations because they present the clinical to the care managers. The UR rep must be able to think quick on their feet, communicate effectively, must be detail oriented, must have great time management skills, must be able to meet deadlines and be able to multi-task. The UR rep must have the skills set to turn a word into a sentence. The reps must be creative with their words especially when describing people and their situations. The reps must have basic knowledge about medical necessity criteria for at least the major insurance companies.
What you should know?
We are here to help improve the clinical documentation in all departments so you will have a better chance at obtaining authorizations. It’s nothing like that great feeling of have a success story about one of your clients because they were given the appropriate amount of days to complete the program. We’ve seen so many clients receive such limited about of days who are then discharged from the facility then end up right back in treatment. Contact us today to schedule a consultation.