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NCAD: Payer audits, crisis communications highlight executive sessions

August 21, 2018

Executive track programming at the National Conference on Alcohol & Addiction Disorders on Monday in Anaheim ran the gamut from taking control of the narrative in times of organizational crisis to evolving sober home standards to understanding technology needs and the forces impacting providers’ revenue streams.

Here are the highlights from a busy day at the Disneyland Hotel:

Crisis communications

The days of straightforward, facts-only reporting in the media are long gone, crisis communications specialist Bruce Hennes explained to attendees. Thus, when organizations have a crisis moment, it is imperative to be prepared to quickly take control of their own message. Hennes offered the following tips: Tell the truth. Tell it first. Tell it all. Tell it fast.

The key players in every crisis story fall into one of three roles, Hennes said: villain, victim or vindicator.

“If you have waited hours—or days—nobody believes you. When the facts don’t fit the frame, people discard facts,” Hennes said. “It is imperative you get your story out, or you will be assigned a role.”

And for organizations and executives who have made mistakes, Hennes said it is critical to “fess up and fix up”: Acknowledge your error and work toward finding a solution.

Sober living standards

Andrew Kessler, founder and principal of behavioral health policy consulting firm Slingshot Solutions, Pete Nielsen, CEO for the California Consortium of Addiction Programs and Professionals, and Dave Sheridan, president of the National Alliance for Recovery Residences, discussed the value of implementing standards for sober homes and how the federal government and states are crafting more stringent regulations.

Kessler said that federal regulations have been tough to implement because while Congress is open to such measures, understanding the role of sober homes in recovery has been a challenging concept for legislators to grasp.

“It’s really confusing because it’s not clinical,” Kessler said. “Usually when you’re talking about a healthcare model, you’re talking about clinical treatment. Because this is chronic, and even beyond chronic, it’s complex in terms of the skills people need to cope and recover, Congress still needs a lot of education. It’s not ‘treatment and you’re done.’ It’s not even ‘treatment, recovery housing, done.’ It goes beyond that.”

Nielson said there is value for sober home operators in organizations such as CCAPP and NARR creating voluntary certifications and credentials.

“It’s important that you have the stamp of approval that shows you’re different from the bad actors,” he said. “If there are incentives for people to get certified, then that helps them to comply. It’s about the health and safety of the individuals. We want to make sure homes are safe and conducive for recovery. The other thing we do in any certification for recovery residences is we make sure there is a good recovery environment as well as safety. Do they have support? We want homes to be good neighbors, and certification helps that.”

Technology considerations

Addiction treatment providers looking to gain a better understanding of their technology needs should start by developing a better understanding of their business and their market overall, said Matthew Dorman, CEO of Credible Behavioral Health Software.

“The key thing is for providers to define what they’re doing, first looking at the services they provide,” Dorman said. “So, if they were list out their programs alphabetically and how much they bill and how much they collect by program, they get a much more realistic view of what they do. Many think they are in children’s services, but in reality, they get more from adult services. Going through and doing those listings by services, then by employee and then client, you get a much better handle on what you do.”

Dorman also recommended that attendees should consider geography to ensure their offices and staff are aligned with where clients are located.

Technology should be a tool that empowers not staff, and not be viewed as another hurdle to providing quality care, Dorman said.

Providers should identify three to four key business drivers and consider how frequently they review those metrics. Also: Understand the difference between metrics that need to be updated in real time versus those that can be refreshed daily or weekly.

When it comes time to choose a technology partner, Dorman shared several considerations that providers should review, including the vendors’ contract churn, number of implementations and terminations within the past three years, and the average length of a software implementation.

Avoiding the audit

With the growth in coverage from both private and government payers has come an increase in scrutiny and potential for providers to face audits. Bragg Hemme and Nathaniel “Tani” Weiner, both shareholders and vice chairs of Polsinelli Behavioral Health Law Group, shared with attendees the ounce of prevention they can implement to avoid needing a pound of cure down the road.

Frequent targets for audits include: medical necessity, lab frequency, physician certifications, physician orders, therapy hours and differentiating levels of care. Lab testing can raise other potential red flags among payers, such as ownership of the lab—a provider owning a lab, for example, could raise suspicion of overtesting to pad the organization’s bottom line.

Pleading organizational ignorance after wrongdoing has been discovered is not an option. As such, Hemme and Weiner recommended that providers follow industry audit trends and conduct their own internal audits periodically, with even a review of 20 to 30 cases being enough to identify potential gaps and missteps. Lastly, understand that payer requirements can vary widely, making across-the-board compliance difficult, so be sure to review contract language, provider manuals, written policies, billing guidance and communications with the organization’s plan representative.

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