Behavioral Health Care Consulting
ABH® offers behavioral health care consulting as part of a full suite of mental health management services. The Health Care Reform Act passed in March 2010 includes legislation that requires Medicare/Medicaid providers to develop compliance plans as a condition of enrollment as a Medicaid/Medicare provider.
ABH provides consulting services for functions including:
- Organizational risk assessment: This service involves reviewing an agency’s policies and practices to identify risks for fraudulent billing
- Claims & Chart Record Audits: This service can be provided as a one-time function or as part of an ongoing contracted service with a provider to ensure compliance with the agency’s compliance policies. Audits are performed to look for the following potential issues:
- Up-coding: billing using a procedure code with a higher rate of reimbursement than the service(s) actually rendered
- Unbundling: utilizing separate procedure codes for services typically reimbursed using a combined payment code
- Services that are not medically necessary
- Billing for services not rendered (as evidenced by lack of documentation to support the services performed)
- Worthless services
- Duplicate billing
- Documentation quality
- Development of compliance policies and procedures
- Development of processes to evaluate and measure effectiveness of compliance policies
- Development of an agency’s annual compliance work plan
- Development and distribution of compliance updates and newsletters
- Development of corrective action plans as needed
- Office of Inspector General (OIG) website queries for all individuals employed by the agency to determine whether any employee is “excluded” from providing services to Medicare/Medicaid clients
- A “Compliance Hotline” for agencies in which ABH provides consultative services to identify and investigate any possible compliance issues
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