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RESULTS

Service Results

At Behavioral Healthcare Advisors we are committed to quality, integrity, and excellence in any service we provide. That means that when we partner together, we commit to a successful outcome. With every engagement, we can provide a suite of services that meet our client’s needs while providing the support necessary for your organization’s success. We believe through collaboration and expertise, a positive outcome for the client is inevitable. We develop partnerships through a systematic process and project management model, and the end goals and desired outcomes will be met according to the scope of work requested. This model has been proven successful throughout the country and we are ready to make it work for you.

CHOOSE THE RESULTS YOU NEED​

The experts at Behavioral Healthcare Advisors have participated in over 320 successful accreditation and licensing surveys for behavioral health organizations, including mental health and substance abuse inpatient and outpatient programs utilizing our proven process.

Organizations include:

  • Commission on Accreditation of Rehabilitation Facilities (CARF)
  • The Joint Commission (TJC)
  • Accreditation Commission on Healthcare (ACHC)
  • Agency for Healthcare Administration (AHCA)
  • State Licensing Boards
  • SAMSHA Opioid Treatment Programs

Services included for both accreditation and state licensing: 

  • Project management of entire licensing and accreditation process
  • Submission of your state’s application and accreditation
  • Compliance Policy and Procedure manuals and forms development
  • Management Plan Development including planning for:
  • Management Strategy
    • Leadership Planning
    • Performance Improvement
    • Infection Control and Biohazard Waste Management
    • Health Information Management
    • Environment of Care Risk Assessment and Plan Development

Human Resources and workforces integration, primary verification and training development

  • Development of performance improvement and reporting model based on key performance indicators (KPIs)
  • Education and preparation for compliance with standards oversight
  • Mock survey and readiness programs
  • Educational training for survey prep
  • Outcome reporting support
  • Customized continuous readiness
  • Life safety and Environment of Care review
  • Safety consultation and disaster vulnerability analysis
  • Clinical documentation, form review & revisio

The experts at Behavioral Healthcare Advisors have participated in over 320 successful accreditation and licensing surveys for behavioral health organizations, including mental health and substance abuse inpatient and outpatient programs utilizing our proven process.

Organizations include:

  • Commission on Accreditation of Rehabilitation Facilities (CARF)
  • The Joint Commission (TJC)
  • Accreditation Commission on Healthcare (ACHC)
  • Agency for Healthcare Administration (AHCA)
  • State Licensing Boards
  • SAMSHA Opioid Treatment Programs

Services included for both accreditation and state licensing: (Should I write a brief description for each and maybe we would put a link for won page or is that to much)

  • Project management of entire licensing and accreditation process
  • Submission of your state’s application and accreditation
  • Compliance Policy and Procedure manuals and forms development
  • Management Plan Development including planning for:
  • Management Strategy
    • Leadership Planning
    • Performance Improvement
    • Infection Control and Biohazard Waste Management
    • Health Information Management
    • Environment of Care Risk Assessment and Plan Development

Human Resources and workforces integration, primary verification and training development

  • Development of performance improvement and reporting model based on key performance indicators (KPIs)
  • Education and preparation for compliance with standards oversight
  • Mock survey and readiness programs
  • Educational training for survey prep
  • Outcome reporting support
  • Customized continuous readiness
  • Life safety and Environment of Care review
  • Safety consultation and disaster vulnerability analysis
  • Clinical documentation, form review & revisions

Behavioral Healthcare Advisors has established relationships with national and regional contracting representatives with the major insurance companies. The team’s extensive experience in the engagement and ultimate execution of an agreement will provide a seamless process with payers and employer groups alike.

Some ways we have helped previous clients with engagement and execution services include:

  • Leveraging established relationships with insurance companies
  • Providing and completing initial contracting (in-network) inquiries with payer
  • Developing payer friendly collateral, based on organization and payer interests
  • Assisting in rate negotiation based on historical knowledge and specific to client’s locale

 

Our team has experience contracting and credentialing with the following payers:

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Our advisors ensure providers will receive prompt credentialing, specific to their needs and the needs of the insurance company. We can oversee:

  • Establishment of NPI number
  • Registration with CAQH
  • Providing National Practitioner Data Base (NPDB) inquiry
  • Primary Verification
  • Complete applications with insurance companies
  • Liaising with appointed credentialing representative
  • Provider contracting
  • Other processes as identified during scope meeting

The Behavioral Health space has been a significant focus for federal, state, and payer oversight. Unfortunately, it is not a matter of if, but when an organization may receive a request from a payer. Requests may include medical records, financial take-back requests, fraud inquiries from a Special Investigation Unit (SIU), billing challenges, and care complaints.

Our experts have participated in various audits, including lab utilization, level of care determination (residential vs. partial hospitalization), billing concerns, take-back requests, patient participation in cost-sharing, fraud review, marketing, and travel concerns, and various investigations. You can feel confident that you are in good hands when we manage these sometimes complicated requests for you.

Companies and entities we have worked with include: CIGNA, United Healthcare, Optum Behavioral Health, Aetna, exchange plan practices, state accrediting agencies, the FBI, DOJ, and DEA.

Some of the items we can manage for you:

  • Liaison with payer and counsel (if needed) with Special Investigation Units
  • Medical necessity review and provide appeal (clinical and/or financial)
  • Review investigation detail and development of integrated corrective management process with an advisor, counsel, and client
  • Review, in detail, documents and/or processes in question and provide a plan to ensure a positive outcome
  • Negotiate settlement or project manage the litigation process as the liaison between counsel, client, and payer
  • Develop corrective action plans and management. Define completion requirements based on the entity and agreements with the organization.

Licensed providers benefit from the extensive experience of Behavioral Healthcare Advisors within inpatient and outpatient program development and evidence-based practices. Through a review of the organization’s milieu and mission, the advisor will partner with the Clinical Leadership team to provide direction and support in programming and staffing efforts. We can identify areas of focus and provide direction to keep things moving forward.

We provide program development and implementation support, mirroring stake-holder set needs, for:

  • Client
  • Community
  • Payers
  • Regulators

Behavioral Healthcare Advisors can:

  • Support leadership efforts in the recruitment and interview process for key positions within the organization            
  • Provide curriculum and evidence-based clinical programming support
  • Review and recommend solutions to an environment of care and milieu concerns
  • Establish a Performance Improvement model that meets organization and clinical client service needs
  • Assess and coordinate with leadership teams to establish a Plan of Care model, based on the specific mission of the organization and client population served

Our advisors have over 20 years of experience working with private equity firms, boards & private investors in De Novo, acquisition teams, and varying start-up projects. We provide a full suite of services to support private equity or PE-backed, investor groups, and the Board of Director’s efforts in creating facility-based and practice-based services. Through a partnership, we will provide dynamic project management and full-scale implementation to the project’s completion.

Project Management and Implementation deliverables may include:

  • Identification of location and zoning requirements
  • Negotiation and execution of a lease and permit verification
  • License location
  • Accreditation for location
  • Policy and procedure manuals
  • Billing and collection software establishment and processes (internal or through 3rd party relationship)
  • Identification and implementation of Electronic Medical Record and vendor interfaces
  • Initial human resource efforts, recruitment, and orientation of new staff
  • Define and implement the optimum intake process, which may include phone system selection, selection of intake model, and referral management and CRM selection

With experience growing multi-location facilities, we can help with sales and marketing plans. Our experience within sales and marketing encompasses the following disciplines:

  • Call center management
  • CRM implementation
  • CRM implementation with EMR systems
  • Marketing planning
  • Event management
  • Outreach process
  • SEO, PPC, and remarketing best practices
  • Website Design and Development
  • Design and Fit Plan Selection
  • Vendor Relationships, including construction and FFE, needs
  • Budget management of Capital Expenditures
  • Local County and State agency relationships
  • Confirm receipt of Certificate of Occupancy

As interim management, our advisors will fulfill onsite leadership roles. Our Advisory team includes former CEOs, COOs, Administrators, Utilization Review Leaders, Clinical Directors, and Chief Compliance Officers. Our average engagement for an advisor is  3-4 months. In that time, we focus on supporting leadership to secure ongoing functionality and identifying a replacement for the role. A unique aspect of our service is that the majority of our experts are licensed in various states and can get licensed as requested to fill positions where licensing is required. The role of our advisor may include:

  • Daily supervision of organization staff
  • Leadership and strategic plan assessment
  • Providing action plan for ongoing projects and oversight
  • Regular reporting and direction from the Board of Directors and Ownership.
  • Growth Initiatives
  • Post-acquisition leadership

 

Data Room Management

  • Organization of data room
  • Seller liason for documentation
  • Regular reporting and review delivery to buyer
  • Liaison with external due diligence participants

Sample Documentation and Report Request in Data Room

  • Budgets
  • Financial and Accounting Documents and report (Tax, KPI reports, monthly and annual reporting)
  • Billing/Collection
  • Contracts – Payer
  • Contracts – Vendor
  • Current Legal and Litigation matters
  • Insurance
  • Benefits 
  • Payer Contracts
  • Corporate Documents
  • HR Documents and Agreements

Reimbursement Review and Utilization Analysis

  • Historical Billing and Collection Performance
  • In-network vs. Out of Network Challenges
  • Audit History and Pending Investigations
  • Payer Perspectives and Contract integration

Compliance Program Review

  • Plan Review
  • Litigation History and current matters
  • Audit History and current matters
  • Historical and current license and accreditation status
  • Contract and Service Agreement Review
  • Credentialing
  • Legal Consultation

Clinical Program

  • Clinical Program Review
  •  Satisfaction Survey Review
  • Outcome Performance Indicators
  • Documentation

Regulatory and Market Assessment

  • Regulatory Considerations
  • Payer landscape
  • Local Payer and Market Dynamic
 

Acquisition and Due Diligence Partnerships

Behavioral Healthcare Advisors team members provide independent owners, and privately held equity companies,  leadership and management services in the acquisition, due diligence, and integration phases. We know the ins and outs throughout the process for facility based organizations focused on mental health and substance abuse, as well as independently owned behavioral healthcare practices.

 

Acquisition Plan Development and Integration

30-60-90 Day Integration Implementation Model and Oversight will include:

  • Sales Team
  • Marketing/Social Media and Website
  • Credentialing and Medical Team
  • Revenue Cycle Management Processes and Software
  • Clinical Programming
  • Compliance and Contracting review and notification
  • Human Resources and WorkForce Assessment
  • Information Technology
  • Finance and Accounting Software

As an organization grows, a compliance representative must ensure processes are set, standards are defined, and a culture of compliance is met.  We know an organization’s size and annual revenue may not warrant a full-time compliance representative. They can benefit from an off–site Compliance Officer, which is considered a leadership team member. The role will meet all requirements of a Compliance Officer, HR documentation and will be on-site as indicated.

Services Provided may include:

  • Implementing the Performance Improvement Program
  • A resource to the leadership team
  • Medical record documentation oversight
  • Develop and implement a compliance plan
  • Lead critical incident reporting and analysis
  • Lead licensing and accreditation efforts
  • Liaison with 3rd party payers and contracting matters
  • Assist the revenue cycle management department with payer audits, appeals, take-backs, SIU investigations, etc.
  • Become licensed (LCSW) in the State facility is located to assist in Clinical oversight as needed
  • Lead monthly performance meeting and KPI review
  • Other tasks as determined by leadership

Behavioral Healthcare Advisors can support organizations that provide DME services to healthcare professionals and directly to clients. Assistance in compliance oversight, audit review, corrective action plans, and UPIC audits ensure the client’s ability to provide Medicare and CMS the appropriate documentation, with minimal disruption to operations and cash flow.

Services include:

  • Completion of CMS 855S applications
  • Completion of Corrective Action Plan
  • Completion of Reconsideration Review Request
  • Management and provide documentation needs
    • Board of Certification Accreditation (BOC)
    • Accreditation Commission for Healthcare (ACHA)
    • The Joint Commission
    • State Licensure
  • Compliance
Our project management model creates a culture of collaboration and accountability for the team members of the organization and the advisor. We have found this model encourages the sharing of information and transparency and ultimately supports a successful outcome and/or ongoing integration as a member of a team all working toward the same goal.
Implementation | Onboarding | Adoption

Projects are managed by our Senior Advisor and the assigned team member from the client organization. Our process provides clients the best service, expanded knowledge, and the ability to be engaged throughout the process: while your team at Behavioral Healthcare Advisors ensures all ultimate goals are met. 

We are dedicated and strive to make a difference. We lead by example, using our voice, knowledge, and resources to act. We will help you define the optimal path necessary to ensure your patients, consumers, and clients are cared for with a standard of excellence. 

Request a consultation with Behavioral Healthcare Advisors to determine how we can be the difference for your organization.