Which utilization review phase involves third-party payers approving a proposed PT prescription program before it is implemented?

Which utilization review phase involves third-party payers approving a proposed PT prescription program before it is implemented?

• A. Concurrent
• B. Retrospective
• C. Statistical
• D. Prospective

Answer: (D)

Prospective utilization review is the pre-approval process where a third-party payer evaluates and approves a proposed physical therapy plan before any services are delivered. This means the plan of care, including the prescribed interventions, frequency, and duration, is reviewed to confirm medical necessity and coverage prior to implementing the program. If approved, therapy can proceed as planned; if not, adjustments or alternative arrangements are made before care starts. During treatment, concurrent review checks ongoing care to determine continued need and resource use, while retrospective review looks back after services to assess appropriateness and reimbursement. The option that involves approval before implementation is the prospective approach.

Prospective utilization review is the pre-approval process where a third-party payer evaluates and approves a proposed physical therapy plan before any services are delivered. This means the plan of care, including the prescribed interventions, frequency, and duration, is reviewed to confirm medical necessity and coverage prior to implementing the program. If approved, therapy can proceed as planned; if not, adjustments or alternative arrangements are made before care starts.

During treatment, concurrent review checks ongoing care to determine continued need and resource use, while retrospective review looks back after services to assess appropriateness and reimbursement. The option that involves approval before implementation is the prospective approach.