Standardized Review of Behavioral Health Case Records for Appropriateness of Care
A comprehensive regulatory and clinically responsive uniform chart review process includes:
- Development of a unique and customized Scoresheet for a standardized review process that measures documentation of treatment appropriateness with specific levels of care.
- Elements are sensitive to recognized medical necessity criteria against state and federal requirements. This can assist with behavioral health care that may be under legal review.
Our scoresheets utilize a methodology to achieve the same review as a government auditing agency. The scoresheets are therefore created to match your unique service, and may include such items as:
- Admission criteria,
- Non-admission criteria,
- Treatment planning,
- Continued stay criteria, and
- Discharge criteria, etc.
Our process provides the clinical and data-driven assessment needed to identify and measure issues related to the appropriateness and quality of the individual’s treatment under question. We provide:
- An objective clinical review. Our expert clinical review team assesses each individual chart utilizing the standardized scoresheet developed for the identified clinical population and level of care.
- A data-metric-outcomes approach quantifying the appropriateness of treatment according to professional and regulatory standards of care.
- A team of experienced and licensed clinicians and administrators to support your knowledge acquisition as you gain your new status.
Our Key Clinical Experts
- SAE CEO & Founder Dr. Steven A. Estrine
- Brian Baldwin, LCSW
OMIG Audit Support and Appeals
SAE has experience in providing organizations with concrete data for OMIG (Office of the Medicaid Inspector General) appeal processes and customized plans to prevent future unfavorable OMIG results.
SAE offers:
- A standardized OMIG protocol assessment utilizing our scoresheet methodology to review case records (in both written and electronic formats) according to reported deficiencies; and
- Clinical expert reviews of chart content using standard protocols while determining whether additional documentation provided by the organization during the appeal process changes the final analysis.
By connecting clinical, administrative, and technological solution elements together for future OMIG audits, SAE is able to:
- Identify unlabeled EHR (Electronic Health Record) content;
- Conduct data dives;
- Identify failure trends; and
- Provide corrective action plans for effective process and practice change.
License Acquisition Services
SAE also provides consulting services related to the development of licensed New York State Office of Mental Health (OMH) and Office of Alcoholism & Substance Abuse Services (OASAS) treatment programs in the following categories:
- Inpatient;
- Crisis;
- Stabilization and Withdrawal;
- Comprehensive Psychiatric Emergency Programs (CPEP);
- Residential;
- Outpatient Clinic;
- Partial Hospitalization; and
- Personalized Rehabilitative Oriented Services (PROS).
SAE has the requisite experience and expertise in the development of these licensed programs and in the preparation and submission of the required applications.
SAE addresses all required elements of the application so that it addresses the OMH and OASAS standards for approval.
These applications include a Needs Assessment based on the behavioral health needs of the population in the proposed service area, and include a description of the Functional Program of the proposed programs.
We look forward to connecting you with the team! Schedule your no-cost consult today.
