Effective Documentation for Greater Authorization

Meeting the administrative demands of utilization review (UR) is complex, can significantly muddle administrative processes, and generate additional operating costs to your Treatment facility. Regardless, engaging in UR and pre-authorization processes are non-negotiable requirements for working with insurance companies. Unfortunately, an all-too-common response to this rigorous but tricky situation is to avoid or eliminate UR documentation, and pursue authorization based solely on treatment records. It must be noted, however, that doing so may have detrimental impacts to authorization outcomes.

A prime example may be seen in a six-month case study performed by Elevated Billing Solutions (EBS). Over this period of time, authorization outcomes were compared between a treatment center which utilized formal UR documentation and a treatment center which did not. The result, depending on the level of care being sought, was a stunning reduction of treatment authorization by 42% to 65% when treatment notes were utilized in lieu of UR specific documentation. Perhaps more illuminating is the fact that when comparing this data to EBS industry averages, skipping UR documentation still yielded an average of 32% less treatment authorization. Viewed in this light, completing thorough UR documentation may be better understood as a strategic investment as opposed to a mere administrative chore.

Diving deeper into the matter, however, it must be noted that not all UR documentation is created equal. At the end of the day, attaining treatment authorization requires the demonstration of medical necessity while painting a clear picture for insurance care managers to make an ethical and informed decision regarding authorization. With the proper focus and an effective template, this is where UR documentation really shines, as painting an effective picture often requires more data than clinical notes offer on their own. Additionally, UR documentation provides an extra layer of support against the risk of insurance take-backs that often follow medical record reviews.

Properly orchestrated, bringing together documentation from the full treatment team (i.e. physician, psych techs, individual and group therapy notes, etc.) along with regular mental status exams and vital assessment tools, direct treatment documentation may be of sufficient quality to maintain peek authorizations outcomes while gaining administrative efficiency. The key to success in this case, is employing the relevant expertise to regularly train and monitor your treatment staff on effective, timely, and accurate documentation practices. Thereafter, retaining a team of skilled utilization review clinicians is essential to ensure that the strength of your documentation is not lost in translation to the care manager.

In deciding how best to meet the administrative demands placed by insurance companies, you have options. Whether a decision is made to fully invest in strengthening all aspects of treatment documentation or to focus on the creation of effective UR documentation, EBS has the expertise to aid in the process. No matter how you proceed, the imperative task in attaining treatment authorization is to heed the wisdom of Stephen R. Covey and not allow that which is urgent to override that which is important.

By Daniel Lancaster, LCSW

Director of Authorizations, Elevated Billing Solutions

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