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Purchasing reviews can occur during or after services have been provided and purchased.
The purpose is to ensure that:
- a participant is receiving or has received services based on medical necessity;
- the services occur or occurred in the frequency and duration specified in the Individualized Written Rehabilitation Plan and the treatment outcomes meet or met the participant’s needs; and
- CRS program staff members are following billing requirements from CRS policies and procedures and providers are rendering services as determined by the CRS counselor and participant.
The review may include:
- a review of the Individualized Program Plan and Individualized Written Rehabilitation Plan;
- therapy assessments and therapy notes, along with treatment plans and treatment data;
- review of medical necessity;
- review of explanation of benefits or denials;
- review of number of hours or days of service provided; and
- review of documentation confirming all billing activities in accordance with CRS policy and standards.