Adapting to Daily Authorization Requirements in Behavioral Health

The behavioral health sector is experiencing another significant shift in authorization requirements.

This latest change demonstrates how Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP) are to be processed.

This trend involves moving from a weekly to daily hours calculation for authorizations.

As a result, a strategic response from providers is needed to maintain compliance and operational efficiency.

The Move From Weekly to Daily Hours

Traditionally, PHP and IOP services were authorized based on the weekly hours required.

However, we’re seeing a growing trend towards daily hour requirements set by many insurance payers.

This change means that each day’s service provision must be authorized individually instead of having a flexible weekly hour allocation.

The Implications for Providers

This shift has significant implications for programs providing PHP and IOP services.

Providers need to adapt their treatment delivery and documentation to this new daily hour system to ensure they remain compliant (and avoid potential issues like claim denials, audits, and recoupments).

Continuing to rely solely on total weekly hours could put your programs at risk and negatively impact your cash flow.

Actionable Steps for Providers

To navigate this industry change effectively, providers should consider the following actions:

  1. Communicate with Your Team: Educate clinical and administrative staff about the new daily authorization requirements. Everyone involved in treatment delivery and documentation must understand the changes and how they impact daily routines.
  2. Review Current Authorization Practices: Assess how treatment hours for PHP and IOP services are currently tracked and documented. Adjust these practices to ensure they can capture and support daily treatment hours, not just weekly totals.
  3. Update Documentation and Billing Processes: Modify documentation templates and billing systems to reflect daily service delivery accurately. This adjustment will help in mitigating risks associated with claim denials and audits.
  4. Stay Informed and Engage with Payers: Regularly communicate with insurance companies to understand their specific daily authorization requirements. Staying updated on payer policies will help preemptively address potential issues.
  5. Seek Support: If facing challenges during this transition, reach out to billing experts or your client success representative for assistance. They can provide guidance and support to ensure your programs comply with the new authorization requirements.

Conclusion

The shift towards daily authorization requirements in PHP and IOP services is a significant trend that behavioral health providers must address proactively.

Providers can align their services with the new industry standards by understanding this shift, communicating effectively within the organization, reviewing and updating operational practices, and seeking support when needed.

This proactive approach will ensure compliance and protect the revenue stream and operational stability of the provider’s services in the ever-evolving behavioral health landscape.