decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Concurrent Care / Concurrent care basics
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Article Overview
This article explains the basics of concurrent care and the general criteria used to determine whether services by more than one clinician may be considered covered and medically necessary. It is intended for coding and billing professionals, clinicians, and compliance staff who need a plain-language overview of concurrent care policy concepts, including provider participation, duplication concerns, coverage substitutions, and situations where the concept does not apply. The discussion is framed at a policy level and does not provide step-by-step coding instructions.
Why This Topic Matters
Concurrent care can affect how services are evaluated for coverage and medical necessity when multiple providers are involved. Understanding the policy framework helps prevent inappropriate billing and supports documentation review.
What You Will Learn
- What concurrent care means in a general coverage context
- How medical necessity is evaluated when more than one clinician is involved
- Why duplicate services may raise coverage concerns
- When substitute coverage during an absence is distinguished from concurrent care
- Why certain service settings are treated differently under this policy concept
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Physicians and other clinicians
- Practice administrators
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