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Even Medicare commission to have services PHP demands concurrent feedback getting proceeded visibility beyond 1st qualification symptoms. Aetna, UHC Optum, and you may Magellan the require concurrent opinion to possess IOP and you may PHP. Apps you to prepare for concurrent comment that have planned systematic explanations and newest ASAM otherwise LOCUS critiques get went on authorizations. Concurrent opinion submissions are typically owed twenty-four in order to 72 occasions just before the current agreement ends. Widely known recharging mistake during the IOP and PHP was double-charging the for each and every-diem and personal course requirements, and therefore produces immediate CO-97 denials. Contained in this a per-diem date, certain services tends to be charged on their own (pass-as a consequence of attributes) in place of breaking the latest per-diem bundling.
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The new CY 2025 finally laws mainly based permanent telehealth exposure to possess behavioral health IOP and you may PHP features getting Medicare beneficiaries. Common when concurrent remark is actually overlooked while the auth expires. Most common when ASAM, LOCUS, otherwise payer-certain severity criteria aren’t recorded within entry as well as concurrent feedback intervals. Generate concurrent comment into the IOP and PHP scientific workflow given that a repeating activity, perhaps not a reactive techniques due to a keen auth conclusion aware.
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