As you know, Pinnacle Partners’ mission is to assist behavioral health agencies not only to survive but thrive in our new managed care environment.
We accomplish this by not only providing consulting and educational services but by working with a small, handpicked network of Subject Matter Experts (SMEs) that we know have the knowledge and experience to guide your organization through these unchartered waters. That is why I am pleased to introduce you today to one of our newest SMEs, Christine Smalley of Smalley & Associates.
Chris has over 25 years in behavioral health management and oversight. She understands the importance of clinical documentation, particularly now that future Managed Care Organization (MCO) clinical audits loom on our horizon. She can assist your organization in making sure that your clinical documentation can stand the scrutiny of a MCO audit.
Ask the SME:
Q: Chris, in your opinion, which Community Behavioral Health services are at risk for a MCO clinical Audit?
A: I think SUD Residential and IOP services will attract the most interest from the MCOs at this time.
Q: Why Do You feel this way?
A: SUD Residential and IOP services have been seen in the past as services provided in a very ordered and systematic fashion. It often appeared that the clients received services because it was in the program or curriculum, not because it was clinically indicated at that time. MCOs have been very forthcoming regarding their desire to see individualized services provided to clients. This expressed priority, “individualized treatment”, could likely be one of the major drivers when services are chosen for audit.
Q: How Should agencies prepare themselves now for the eventual MCO Audit?
A: The best way an agency can prep for an audit is to be proactive through utilization of a strong Quality Assurance (QA) system. Completing an honest self evaluation of your agency’s programming and clinical documentation, establishing a process whereby QA focuses on medical necessity in documentation and training staff to consistently demonstrate “why this client, why this service and why today” will set your agency on a path that will greatly improve the outcome of any future MCO audits.
You can contact Chris at email@example.com or by cell phone at (330) 421-4474. I know she will be of great assistance to your organization.
As always, please let us know how Pinnacle Partners can continue to be of assistance to your organization!