Top 7 Mistakes Made In Utilization Review

When the utilization manager makes the ‘faux pas’ Before I write any further articles I really want to make something perfectly and publicly clear.   I MAKE MISTAKES More specifically, even in physical therapy clinical review I have made mistakes.  Mistakes are made everyday in rehab authorization review. As much as we in utilization management […]

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Top 8 Reasons Care Was Denied: Part 2

Wait a minute….. Whoa!!  Hold on a second, did you read part one yet?  Come on, would you just jump right in and read New Moon without having read Twilight? How else would you know of Bella’s deep undying love of the undead? Or even worse, watch Star Wars The Last Jedi without having seen […]

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Top 8 Reasons Care Was Denied

Part 1, Reasons 1-4 “This is not a time for tact” Certain situations call for just the right amount of tact: Trying out a new anatomy based pick-up line at your next rehab conference “You know what muscle causes the lateral rotation of my cervical spine? Your gluteus maximus”; Your patient starting to explain their […]

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Medical Necessity In Rehab

Two Important Words Before I go too deep into the world of rehabilitation utilization and clinical review I think it important to establish an understanding of one very key phrase: Medical Necessity.  Just about all decisions involving the health care of an individual revolve around those two words. You would think, that with basically two […]

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A Day In The Life

of a physical therapy clinical reviewer Part 1 Sing-A-Long To the tune of “A Day In The Life” by John Lennon/Paul McCartney.  Lyrics by me 🙂 I was in the news today, oh boyJust a lucky man who made the gradeAnd though the news was rather gladWell, I just had to laughI saw the photograph I blew […]

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The BIG Question In Pre-Authorization

Where’s the Beef [aka PT visits]? A new year has just started, and this is the starting of a new and exciting PT/rehab related blog (that I know you are just going to love! Who doesn’t love talking about health care problems and insurance issues?). Being my first real blog post, I wanted to start […]

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