{"product_id":"the-intensive-outpatient-and-partial-claire-alderton-9798187668083","title":"The Intensive Outpatient and Partial Hospitalization Program Operations Manual: Admission Criteria, Staffing Models, Per-Diem Billing Workflows, Concu","description":"\u003cb\u003eBuild an IOP or PHP Program That Can Survive Clinical, Billing, and Payer Review\u003c\/b\u003e \u003cp\u003e\u003c\/p\u003eRunning an Intensive Outpatient Program or Partial Hospitalization Program requires more than a strong clinical schedule. Every referral must fit the payer, setting, level of care, certification, authorization, documentation, service count, claim, and financial model. This manual connects those decisions into one operating system. \u003cp\u003e\u003c\/p\u003e\u003cb\u003eRoute Every Referral Before You Select a Code\u003c\/b\u003e \u003cp\u003e\u003c\/p\u003eStart with the payer and setting. Confirm whether the organization can bill IOP, PHP, both, or neither under the applicable framework. Separate Medicare condition-code billing from Medicaid and commercial HCPCS pathways. Use payer abstraction worksheets, source registers, consent controls, and date-boundary rules before a patient enters a schedule the setting cannot support or bill. \u003cp\u003e\u003c\/p\u003e\u003cb\u003eDesign the Clinical Model Around Active Treatment\u003c\/b\u003e \u003cp\u003e\u003c\/p\u003eBuild nine-hour IOP and twenty-hour PHP schedules with genuine therapeutic content, qualified staff, physician direction, nursing and case-management coverage, crisis procedures, outcome measurement, and state-rule verification. Completed schedules show how to separate active treatment from breaks, social time, and administrative activity that cannot support the program hour floor. \u003cp\u003e\u003c\/p\u003e\u003cb\u003eTrace Medical Necessity From Admission Through Every Patient Day\u003c\/b\u003e \u003cp\u003e\u003c\/p\u003eUse patient-specific physician certifications, recertification tracking, treatment-plan governance, admission examples, medical-necessity language comparisons, and quality scorecards. Then connect each distinct service to an individualized note, a daily service-count worksheet, the treatment-plan goal it addresses, and the rate tier the chart can defend. \u003cp\u003e\u003c\/p\u003e\u003cb\u003eConstruct and Scrub IOP and PHP Claims\u003c\/b\u003e \u003cp\u003e\u003c\/p\u003eWork through condition codes, types of bill, revenue codes, institutional claim fields, interim billing, FQHC and RHC mechanics, coordination of benefits, payer changes, discharge status, clearinghouse responses, remittance reconciliation, and payer-specific code selection. Annotated claim examples and a claim-scrubbing SOP show exactly what to confirm before submission. \u003cp\u003e\u003c\/p\u003e\u003cb\u003eManage Authorization as a Continuous Clinical and Revenue Process\u003c\/b\u003e \u003cp\u003e\u003c\/p\u003eBuild authorization trackers, concurrent-review evidence packets, reviewer call summaries, peer-to-peer preparation, appeal pathways, and complete authorization trails. The manual separates authorization from payment and shows how to coordinate the clinical, authorization, and billing boundaries when a patient steps up or down between levels of care. \u003cp\u003e\u003c\/p\u003e\u003cb\u003ePrevent Denials at Their Actual Point of Origin\u003c\/b\u003e \u003cp\u003e\u003c\/p\u003eTrace each denial to admission, certification, documentation, claim construction, or authorization. Use root-cause worksheets, responsibility maps, corrective-action logs, appeal templates, quarterly trend reports, payer-specific playbooks, and write-off standards. Fix the upstream process while pursuing the individual claim when the genuine record supports payment. \u003cp\u003e\u003c\/p\u003e\u003cb\u003eLaunch With Tools Built for Ongoing Operations\u003c\/b\u003e \u003cp\u003e\u003c\/p\u003eNine sequential chapters and four appendices provide staffing and capacity calculators, payer-mix models, leakage analysis, break-even worksheets, launch-readiness audits, ownership matrices, regulatory calendars, audit-response procedures, competency checks, and a full patient-journey document map. The Riverside and Fairview examples carry decisions from referral through payment, denial, correction, and annual maintenance. Use the manual before launch, during a live payer problem, or as a standing desk reference for a mature behavioral health program. Every dated rate, code, interval, and payer rule is treated as a verification target, so your team can update the operating system without rebuilding it from scratch anew.\u003cbr\u003e\u003cbr\u003e\u003cb\u003eAuthor:\u003c\/b\u003e Claire Alderton\u003cbr\u003e\u003cb\u003eISBN-13:\u003c\/b\u003e 9798187668083\u003cbr\u003e\u003cb\u003ePublisher:\u003c\/b\u003e Independently Published\u003cbr\u003e\u003cb\u003eLanguage:\u003c\/b\u003e English\u003cbr\u003e\u003cb\u003ePublished:\u003c\/b\u003e 07\/17\/2026\u003cbr\u003e\u003cb\u003ePages:\u003c\/b\u003e 222\u003cbr\u003e\u003cb\u003eFormat:\u003c\/b\u003e Paperback\u003cbr\u003e\u003cb\u003eWeight:\u003c\/b\u003e 1.16lbs\u003cbr\u003e\u003cb\u003eSize:\u003c\/b\u003e 11.00h x 8.50w x 0.47d","brand":"Claire Alderton","offers":[{"title":"Paperback","offer_id":48997942624511,"sku":"9798187668083","price":199.99,"currency_code":"USD","in_stock":true}],"url":"https:\/\/www.whiterainbookhouse.com\/products\/the-intensive-outpatient-and-partial-claire-alderton-9798187668083","provider":"WR Book House","version":"1.0","type":"link"}