Utilization Review Training (UR)

The Addictions Academy training at Crossroads Turning points, inc.A vital component to the bottom line of any addiction treatment center or mental health facility 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 the general well-being of the program in the recovery community. If your UR team is not trained they will not get the proper amount of days for the client and you will not get paid properly. Wrong codes, incorrect codes, not understanding the diagnosis or human error can attribute to not receiving the correct amount of insurance per patient or denials pilling up. We will teach your team how to correct that.

Our Utilization Review Training 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 I learn? 

  • 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 the 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 a 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.

What is Utilization Review? UR review is the job of translating the therapist’s notes, ASAM, and DSM 5 diagnosis into the platform and reporting to the billing team at the various insurance agencies to collect the insurance reimbursable for the client in addiction treatment or mental health treatment. It is most successful on a doc to doc review.

How do I train my team in Utilization Review? The Addictions Academy’s online specialized training for mental health and addiction treatment professionals will assist you in getting a better understanding of UR and what the ASAM and DSM 5 coding needs to be. These codes will help you get the most reimbursement with insurance billing companies, fewer denials, and less repeat billing problems.

Who does a Utilization Review? The mental health or addiction treatment team UR division will do the review on a peer to peer basis. The more training the UR person has, the better and more comprehensive review and the better the chances of getting paid properly the first time occur.

How much does a Utilization Review Coordinator make?   Most UR professionals will make $38,000 to $45,000 and can also obtain bonuses on the work performance or a percentage of billing collectibles.

This course is set up for an individual to join an easy to use a web-based platform and we offer this class live via the web and for an unlimited number of people at one price.  Please click the button below to register and pay or call us to schedule the date and time you need the training. If you have a treatment center and want us to train the entire staff we can arrange that via the web or a live in-person class. For treatment center and large groups please call us at 800 706 0318 ext 2

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Utilization Review Training - IAAP Approved Course