The Complexity of Using an Electronic Health Record in the Behavioral Health Environment
Are your EHR, clinic and staff ready for:
- Use of a single axis diagnosis and claims process? The DSM-V removed the multi-axial documentation. It eliminates Axis I, II and III and has V codes for the formerly documented Axis IV psychosocial and contextual factors, and a self-report tool for disability and function for the previously noted GAF on Axis V.
- Elimination of "Not Otherwise Specified" NOS? The DSM-V allows a new designating of "Not Elsewhere Classified" NEC which includes a list of specifiers for the reasons why the condition does not meet the more specific disorder. NOS will no longer be accepted.
- Diagnostic criteria changes? The severity designation for individuals diagnosed with Intellectual Disability/Intellectual Developmental Disorder will now be determined by adaptive functioning and not IQ score. Subtypes (such as paranoid, disorganized, catatonic, and undifferentiated) for the diagnosis of Schizophrenia will no longer be recognized. Now, there are four symptom clusters instead of three for Post-Traumatic Stress Disorder, and avoidance/numbing is divided into two clusters of avoidance and persistent negative states. A diagnosis of a substance use disorder will not include either the identification of "abuse" or "dependence", but criteria sets are now provided for the "intoxication", "withdrawal" and "substance/medication-induced" categories, which must be designated with a level of care consistent with the category.
The changeover process from the DSM-IV to the DSM-V is not just a matter of assessing and upgrading clinical knowledge about the various differences in criteria and diagnostic categories for your populations of focus. Indeed, if this were so, then assessment forms would be the only practice change to implement. However, it is not. Screening tools, engagement questionnaires, treatment planning templates, process notes for individuals, groups, couples, and family sessions, and discharge planning forms must now all be consistent with the changeover process in documentation and treatment verification.
The repercussions of these gaps can affect billing and treatment authorizations, not to mention licensing and ethical questions of treatment competency, access to care and treatment fidelity.
Is your clinic ready to demonstrate effectiveness in care with the new DSM-V and the simultaneous change over to ICD 10? Are supports still needed to provide appropriate documentation and to address gaps in administrative oversight to better the revenue management process informed byUtilization Review and Management for case management with payer systems that will require use of DSM-V diagnoses and codes?
Can your solution be as simple as leaving it to your electronic health record (EHR) vendor? Only if there is existing confidence that behavioral health domains, with all the current changes in service types and models of integrated care and care coordination with allocation of pay-for-performance HEDIS measures are being well managed and represented in your existing system. Thus, whenever your clinical staff provides an intervention on smoking cessation for their diabetic, schizophrenic tobacco-smoking client, the mapping of relevant values must capture that treatment efficacy, and verify treatment engagement and retention. This is essential, given the move to value-based care and reimbursement structures that recognize the most proven cost-effective care.
If you don't act in a timely manner, being unprepared can cause delays in the dropping, adjudication and payment of claims, which can adversely affect the revenue cycle. Unless your organization has significant cash reserves or access to a line of credit, disruptions to cash flow can impact your ability to fund daily operations, so it is especially critical that key stakeholders from your billing and clinical staff meet to address this change process. Are there new billing exception reports to identify flawed claims? Who will train your clinicians on how to document changes to the DSM-V for billing purposes? These are some of the questions that must be addressed to ensure a smooth transition.
SAE can help.
From implementing an integrated care model to ensuring an integrated electronic health system, SAE can help you successfully navigate and develop the necessary skill sets and infrastructure to excel and document your treatment success. Feel free to reach us by phone (212.684.4480) or send an email to firstname.lastname@example.org for more information.