18 Jul 2017 Digital

How to Clinician-Proof Your Treatment Center For an Audit

Matt Stevens
Matt Stevens
Co-Founder, Alleva

You might be thinking: clinician-proof? The clinicians are on our team; they’re the good guys! Why would we ever need to protect our facilities from them?

Allow me to clarify. While quality clinicians provide incredible care to your clients, many are not motivated to properly document their work. These clinicians can be a sizable liability for your treatment center.

Why is documentation so important in sustaining your facility’s operations? Recent healthcare policies have placed greater responsibility on insurance companies to pay for addiction treatment services. As such, insurers have intensified their scrutiny of claims to ensure they do not pay more than required. If your clinicians are not properly documenting their services, reimbursements will be denied, and your facility will be financially strained.

Let’s explore an example:

Patient A is in a life-threatening situation. He qualifies for a higher level of care and supervision. The necessary steps have been taken and paid for by your treatment facility; however, the reimbursement is denied because the patient’s status was not properly documented at the time of his treatment. Now, it’s impossible to prove that Patient A was truly in need of more intensive care. Herein lies the danger: regardless of the reality of a patient’s needs, the funds provided by an insurance company are determined from your clinician’s notes and records.

So what can be done? Rather than firing all of your clinicians, and hiring scribes in their place, I recommend that you simply “clinician-proof” your treatment center for an audit. Electronic medical record companies like Alleva are equipping treatment facilities with software solutions to facilitate proper documentation across their organizations. Here are some documentation best practices we recognize at Alleva; we’ve integrated many of these into our products:

  1. Require notes to include necessary ASAM criteria for every individual therapy. This will ensure you have all the documentation needed for utilization review calls.
  2. Encourage clinicians to tie their notes to specific objectives and goals in a patient’s treatment plan. This will help insurance companies follow a patient’s progression within a treatment plan so they can validate various services provided.
  3. Encourage a word minimum. Insurance companies will reject documentation they deem as incomplete. Establishing a word minimum is one way to motivate thorough notes. Our product alerts a clinician if his or her notes are sparse to encourage more comprehensive documentation.
  4. Mandate deadlines and timetables. Notes can also be deemed invalid if they are not documented in a timely manner. Our service provides an option for proactive alerts which are sent out in a hierarchy to the clinician, their supervisor, and the billing manager as time passes to ensure notes are finalized on time.
  5. Provide a word bank. Alleva offers a word bank within its system for clinicians to select terms that insurance companies scan for in clinical notes. This helps to bridge the communication gap between clinicians and insurance companies. Often miscommunications can result from a clinician’s personal vocabulary and insurance companies can misinterpret the services provided. Word banks allow clinicians to document in a way that insurance companies understand.

Although these solutions are simple, they have considerable value. This is ultimately the power of well-designed digital solutions like EMR software: they integrate seamlessly into your day-to-day routines and simplify your operations. Most importantly, they allow you to focus your efforts on providing quality to your clients.

What benefits have you seen from integrating digital solutions in your operations? Share in the comments below.

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