Prospective Review includes which of the following true statements?

Prospective Review includes which of the following true statements?

• A. It includes the initial review conducted before treatment starts and the initial review for treatment to a different body part.
• B. It occurs after treatment is completed.
• C. It is used only for inpatient services.
• D. It has no relation to preauthorization.

Answer: (A)

Prospective Review is a preauthorization step used to determine coverage before services are provided. It applies not only to the first treatment plan but also to any subsequent plan that involves a different body part, requiring an additional initial review to secure authorization for that new treatment. This means the process happens before care is delivered, which is why it fits the description of prospective review. It is not something that happens after therapy is finished (that would be retrospective). It isn’t limited to inpatient services—preauthorization can apply in various care settings. And it is directly connected to preauthorization, not unrelated to it.

Prospective Review is a preauthorization step used to determine coverage before services are provided. It applies not only to the first treatment plan but also to any subsequent plan that involves a different body part, requiring an additional initial review to secure authorization for that new treatment.

This means the process happens before care is delivered, which is why it fits the description of prospective review. It is not something that happens after therapy is finished (that would be retrospective). It isn’t limited to inpatient services—preauthorization can apply in various care settings. And it is directly connected to preauthorization, not unrelated to it.