Unique Courses on Our Website
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 '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.
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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