September 2024: ROC Monthly Mastermind Call
September 2024: ROC Monthly Mastermind Call
Mitigating Risk & Increasing Revenue in Treatment
Thanks to our good friend, James Witteck, from Wellbrook Consulting, for joining this month's Mastermind meeting. We discussed the importance of ROI and compliance in behavioral health, emphasizing the need for a solid regulatory and compliance framework.
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Couldn’t join us? Here’s what you missed.
James delved into the complexities of shifting from out-of-network to in-network partnerships, exploring the ripple effects of payer guidelines and the importance of precise data collection.
He emphasized the vital role state licenses, accreditations, and ASAM guidelines play in maintaining operational excellence, saying it's a delicate balance between compliance and revenue growth, the strategic involvement of third-party revenue companies, and the power of fostering a unified organizational culture to drive compliance and risk management success.
Key Takeaways from the Discussion:
Consider implementing regular clinical chart audits to monitor compliance and provide performance feedback.
Evaluate current data collection practices and track all call outcomes for utilization review.
Assess documentation to validate lengths of stay and utilization review decisions.
Transition to In-Network Relationships
The transition to in-network relationships presents challenges, particularly in managing acquisition costs and navigating high-per-diem reimbursements. Building stronger relationships with insurance companies is essential, as they directly affect the cost per admission (CPA) and can significantly influence financial outcomes.
Data Collection and Compliance
Collecting data on all calls, including those resulting in out-of-network referrals, is crucial for ensuring accurate data that supports informed decision-making. Developing an in-house KPI matrix program to track admissions and referrals can further enhance this process, offering a more structured approach to monitoring performance and improving outcomes.
Evaluating Compliance and Clinical Documentation
James outlined the various levels of compliance, beginning with legal obligations and extending to state and accreditation standards. He emphasized the importance of conducting thorough clinical chart audits to ensure adherence to ASAM (American Society of Addiction Medicine) guidelines. Additionally, he highlighted the need to track compliance over time, allowing organizations to identify patterns and drive continuous performance improvement.
Balancing Compliance and Revenue
Balancing compliance with revenue while keeping an organization lean and agile can be a complex challenge. James emphasized the importance of understanding the potential risks of non-compliance and making informed decisions to mitigate those risks. Effective leadership is key, starting with open, transparent discussions about risk management.
Clear communication is essential to prevent misunderstandings and ease any fears within the workforce, particularly in small to mid-sized teams that rely heavily on payer relationships. Building camaraderie and fostering cooperation across the organization are crucial for ensuring stability, driving innovation, and supporting long-term growth.
James F Witteck
Wellbrook Consulting
Senior Partner, Licensing & Accreditation
James is the Senior Partner for Licensing & Accreditation at Wellbrook Consulting, a member of the NAATP Board of Directors, and the Founder and CEO of Sycamore Behavioral Healthcare.
James is trained in healthcare risk management and has led national site development campaigns for several large healthcare companies. With years of professional experience in building, licensing, and managing behavioral health facilities, his company delivers facilities that create durable, data-driven results that help save and change lives. His work supports his passion for providing hope and healing to those individuals and families who continue to suffer from mental health and substance use disorders.