Behavioural Healthcare Compliance

Filled under: Healthcare Compliance on November 2010

Within each aspect of healthcare, there are many different aspects that play a role in the diagnosis and the treatment of any one patient. However, there is no place that this is more obvious than in the behavioural healthcare field. Because of the diversity of conclusions in behavioral healthcare, there are additional restrictions that providers and facilities must abide by in order to work in conjunction with Medicaid (the number one provider of coverage for most behavioural and mental health patients in the nation).

With the enactment of the Medicaid Integrity Program, and each progressing year in which regulations get more restrictive or change, providers and facilities are under even more scrutiny from the powers that be. This is because of the nature of behavioural health. Unlike other fields of medicine where there are tried and true methods for treating certain ailments, behavioural health must remain flexible as no two patients are alike and, thus, may react differently to different lines of treatment.

The easiest way to ensure that any facility is in compliance with the new regulations and up to date on any changes that may have taken place is to establish an internal compliance program. By doing this, all claims that are sent to CMS (Centers for Medicare and Medicaid Services) will be checked and re-checked to ensure that they are correct and appropriate according to the regulations in place. Furthermore, an internal compliance program will help to meet the goals of CMS by reducing the amount of wasteful claims and fraudulent claims that are sent in.

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