|
Behavioral health and social service organizations
have experienced environmental changes that directly
effect their financial performance and stability.
Tight budgets, changes in financial reimbursement
models, reduced fees and managed care have resulted
in loss of business, significant collections and
cash flow problems, as well as deficits/losses. In
order to survive and thrive, behavioral health and
social services organizations must be able to
determine and control the cost of delivering
services, set target pricing to succeed in a
competitive environment, assume and manage risk,
plan for and achieve a reduced cost structure
through operational efficiencies and develop
compensation models that improve productivity levels
by aligning employee’s interests with the interests
of the organization.
Financial Management &
Financial Risk Management
OPEN MINDS financial management & financial
risk management consulting is designed to apply
cutting-edge financial management models and
techniques to behavioral health and social service
organizations. In addition to offering technical
expertise, OPEN MINDS is adept at applying
these principles within the unique culture and
construct of mission driven organizations. Our
financial management & financial risk management
consulting engagements have included:
Medicaid Billing Assessment
Case rate and capitation rate analysis and
development
Incurred but not received (IBNR) calculations
Financial risk management systems
Budget and pro forma development
Cost accounting system assessments
Development of performance-based compensation models
Due diligence for potential acquisitions and
partners
Risk Management &
Compliance
Risk management issues, including compliance, have
been key issues for behavioral health and social
service executives for several decades. Prevention
of critical client incidents and assuring compliance
with public policy and best practice are on-going
concerns. However, new risk management issues have
arisen in the past few years. Compliance planning is
now required to assure adherence with all applicable
federal, state, and local laws, rules, and
regulations as well as with the program requirements
of federal and state sponsored health plans, such as
Medicare and Medicaid. In addition, since Congress
passed the Health Insurance Portability and
Accountability Act of 1996 (HIPAA), the U.S.
Department of Justice’s Office of the Inspector
General has been mandated to establish programs to
detect health care fraud and abuse as well as to
encourage the public to report it. Most importantly,
HIPAA also broadened the definition of “knowing and
willful conduct” with regard to the civil provision
of the Social Security Act to include acts of
“deliberate ignorance” by providers with respect to
information and regulation.
OPEN MINDS risk management and compliance
consulting is designed to assist behavioral health
and social service organizations to:
Fully comprehend the framework, requirements and
operation of a compliance program
Understand the risks and ramifications associated
with failure to comply
Determine the components of an effective compliance
program and how to operationalize them within their
organization on an on-going basis
Secure tools that enable efficient and effective
implementation of a compliance program
OPEN MINDS consultants have assisted
behavioral health and social service agencies in the
development of their corporate compliance plans,
conducted preliminary compliance audits of key risk
areas (including billing and claims payment, medical
record documentation, admissions and referral
mechanisms, and provider credentialing and
contracting) and assisted agencies to develop
corrective action plans, as well as developed and
delivered compliance training programs. |
