Concurrent Review

What Is Concurrent Review in Healthcare?

If you've ever spent time at a bustling clinic around 7 a.m., coffee in hand, files piling up, and phones ringing off the hook, you know healthcare is a dance between patient care and paperwork. There’s one particular piece of paperwork that quietly shapes this dance more than most: concurrent review.

I’ve walked hospital halls, sat in small therapy offices, and talked with clinicians who groan whenever the phrase "concurrent review" pops up. Why? Because if it's mishandled, the ripple effects can quickly become waves—delayed reimbursements, disrupted care, and frazzled staff.

But here's the thing: when understood and handled right, concurrent review doesn’t have to be your practice’s Achilles' heel. It can actually become a reliable ally in the complicated relationship between providers and insurers. Curious yet? Let’s dig in.

What is concurrent review?

Simply put, concurrent review is when an insurance company checks in mid-treatment to decide if they'll keep covering the services a patient receives. Unlike prior authorization—which everyone seems familiar with—this review happens after care has already started, but before it’s finished.

Think of it like a halftime assessment during a football game. The payer pauses, evaluates the progress, and decides whether it's worth continuing to fund the current plan of action or if adjustments are necessary.

At its core, concurrent review is a type of utilization management. It’s meant to ensure care remains medically necessary and to prevent excessive or inappropriate use of healthcare resources. While it sounds straightforward on paper, the reality can feel anything but—especially when you’re buried under patient notes at 3 p.m. on a Friday.

Why concurrent review matters

Honestly, I’ve seen enough claim denial letters on clinicians' desks to last a lifetime. Many of these rejections trace back directly to mishandled concurrent reviews. Here’s why that matters:

First, let’s talk dollars. Denials aren’t just frustrating—they’re costly. Medical necessity denials make up a sizable chunk of lost revenue for clinics nationwide. Imagine your practice losing even 10% of its monthly income due to missing or inadequate documentation. Not pretty, right?

Second, concurrent review directly influences patient care. It helps clinicians pause mid-treatment, reevaluate their approach, and ensure the patient's still on track. It might feel tedious, but I've spoken with experienced therapists who reluctantly admit it can sharpen clinical reasoning—if handled thoughtfully.

Third, compliance and payer relationships rely heavily on timely, accurate reviews. Fail to submit documentation within the insurer’s deadlines, and you’ll quickly find yourself in a sticky web of audits or clawbacks. Trust me, no one wants to end up there.

Finally, a smooth concurrent review process can actually bring peace of mind to your practice. Predictability is rare in healthcare—but if you know exactly what documentation you'll need and when it's due, your staff can breathe a little easier. (And maybe you’ll even finish your coffee before noon.)

How concurrent review works

So how does concurrent review actually unfold? After years spent in and out of healthcare offices, here’s the basic play-by-play I've observed repeatedly:

Step 1: Initial authorizationIt starts with prior authorization, a familiar gatekeeper. The insurer initially approves a set number of visits or treatment days—think 12 physical therapy sessions or two weeks of intensive outpatient therapy.

Step 2: Treatment beginsCare kicks off, and patients start making progress (hopefully). Therapists record notes diligently, but at first, it feels like business as usual.

Step 3: Concurrent review triggeredHere’s where things change. As you approach the original authorization limit, your staff must prep documents for submission. Typically, insurers specify exactly when the review needs to happen—maybe every ten sessions or halfway through the authorized timeframe.

Step 4: Documentation submissionYou compile updated therapy notes, revised treatment plans, new assessment results, and maybe even a clinician’s justification for why the care is still necessary. (Hint: "patient making steady progress" often isn't enough—you'll need data, specifics, and clinical rationale.)

Step 5: Payer evaluationThe insurer’s utilization management team dives into your submitted records. This step is where uncertainty creeps in. Will they approve continued sessions? Request more info? Suggest scaling back?

Step 6: Response and adjustmentOnce the determination is made, your practice pivots accordingly—either continuing treatment smoothly, shifting your care plan, or preparing appeals for denials.

A quick but crucial tip: don’t wait until you're completely out of authorized visits to start your concurrent review process. I've heard too many clinicians lament that missed deadlines have cost them dearly. Early submission is key.

FAQs

What’s the difference between concurrent review and prior authorization?Concurrent review occurs mid-treatment to check ongoing necessity. Prior authorization is the initial approval required before treatment begins. Both involve insurers evaluating medical necessity, just at different care stages.

Do all insurance plans require concurrent review?Not every plan requires concurrent review, but many commercial insurers, Medicaid-managed care, and Medicare Advantage plans do—particularly for ongoing or intensive therapies. Always double-check payer guidelines upfront.

What documentation is typically required?Usually, you'll need recent progress notes, updated treatment goals, clinical assessments, and measurable outcomes demonstrating progress. Occasionally, payers may also request direct clinician input via a phone call or secure messaging.

How often do concurrent reviews happen?Review frequency varies by insurer and treatment type. Some require checks every 30 days, others by session count (every ten visits, for instance). For intensive care situations, weekly reviews aren’t unusual.

What if a concurrent review is denied?You can appeal—but brace yourself, because appealing can be a long haul. Services provided after a denial might not be reimbursed unless you successfully overturn the decision. Pro tip: prevention beats appeal every time.

Conclusion

Concurrent review might not be glamorous—okay, it definitely isn’t glamorous—but over the years, I've seen firsthand how essential it is to navigating the modern healthcare landscape. Yes, it involves paperwork. And yes, deadlines are tight and documentation demands can seem overwhelming.

But think of concurrent review as preventive medicine for your practice’s financial health. With some proactive preparation and clear communication among your team, you can reduce stress, safeguard revenue, and maintain consistent patient care.

So next time the phrase "concurrent review" pops into your inbox, take a deep breath and tackle it head-on. Because knowing the rules and staying ahead of the process makes all the difference. And maybe—just maybe—it’ll make your next early-morning coffee feel a bit more satisfying.