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The Insurance Company's or Contract Manager's Treatment Authorization Process and YOUR Documentation in Client Records .... a.k.a. 'What Can Go WRONG in That Chart?'
SUMMARY: This course is a nice 'companion piece' to Ethics Courses 3D and 4D - which focus upon the ETHICS of documentation in client records and related issues, when insurance is paying the bill. This Course 2B takes it a step further, in demonstrating the typical 'holes' in clinical records and the 'holes' in the thinking of even the most experienced mental health and AOD practitioners, which must be avoided if you are to pass a clinical review of your treatment records, unscathed.
This material applies to those in private practice who have a Provider Agreement with either a commercial insurance company or an HMO which is administering the State's Medicaid or Medicare plan. Particularly with the coming of the new Federal Health Care Reform, no professional is unaffected, unless they limit their practice to private pay clients.
Much of the material in this short course also relates to how we - as treatment providers who are always at risk of falling into legal and professional potholes - can avoid setting ourselves up for problems which oftentimes result from failure to document crucial issues in our clients' records.
The course also provides a clear explanation about HOW those insurance companies make pre-authorization decisions to APPROVE or DENY your requests for treatment . . . and WHAT you must write in the client's chart to support that authorization. It's all about how to ENSURE that you will be ready when the MCO or State auditors appear at your door.
AVOID RECOUPMENT! Failure to properly DOCUMENT certain details of the client's treatment and his need for treatment is the primary reason for RECOUPMENT (taking back) of funds already paid to you by the government contractor or the insurance company. How we document treatment has CHANGED with the coming of Care Management! This course gives you clear 1-2-3 information about how to document effectively - within the bounds of good professional practice.
Click Here to Go to the Catalog for Course 3A Managed Care - Is There Anything GOOD About It? -
THIS is the course for you if you just want the essential basics of managed care! And try 2B and 2C for some additional information about the details of the "new" documentation in client records under managed care. These have some of the 3A in them, but also more.
This course emphasizes how innovative, non-traditional counseling, case management, and support services can be provided under the new managed care models, particularly for difficult, recidivistic, high-risk clients - a natural fit for EAPs and AOD providers of Dual Diagnosis services.
Although "managed care" has become known as an increasingly "medical" model – necessitating that services be deemed essential to recovery and adaptive functioning – in this course we address the positive changes which this shift has brought to the behavioral health field, as well as the challenges. The 'positives' include flexible home-, job-, and school-based interventions utilizing non-institutional case management and support services for children/adolescents, adults and youth with substance abuse issues, and adults with depression and other mental health problems.
The final lesson in this course focuses upon the details of how Care Management departments make decisions to approve or disapprove requested services, and how these decisions can impact your clients' recovery process. Such understanding is essential in order for EAP service providers to accommodate to this shift in treatment and counseling emphasis.
NOTE: Part of the material in this course has information found in MODULE 201 of both of the FlexiCourses (4A and 5A). So you can skip those, if you take this course.
In most states, it's goodbye to flexible addiction Block Grants and other 'open access' State contracts for substance abuse and chemical dependency – which makes access to AOD services even more difficult. This course addresses the 'nitty gritty' of the major CHANGES in SA-CD programs – referral criteria, treatments and interventions available, documentation of need for treatment and response, and philosophy – due to the new health care reform environment. Applies to single AOD diagnosis and to Dual MH-AOD diagnoses.
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