Substance Abuse Facility and/or behavioral health review require specialized knowledge of levels of care that are quite distinct from standard medical surgical care.
Proper treatment level and qualified practitioners are essential to produce quality outcomes. Utilization recommendations are based on therapy needs and severity of impairment.
Repetitive and medically unnecessary drug screening costing thousands of dollars is often encountered in substance abuse treatment centers. Unbundling of per diem daily program fees into multiple lines of labs and therapy setting charges is not uncommon.
Repricing of behavioral health and substance abuse care requires a thorough knowledge of settings and therapist practitioner levels.
Key psych/substance abuse review areas include:
1. Level of care and intensity of service
2. Facility repricing and audit
3. Facility staff credentials and licensure level
4. Detox vs. Rehab duration and level
5. Drug Screen Testing: medical necessity and frequency
6. Outpatient therapy prior authorization review