Standardized Review of Behavioral Health Case Records for Appropriateness of Care
A comprehensive regulatory and clinically responsive uniform chart review process that 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 will therefore be uniquely created to your service, and may include such items as: admission criteria, non-admission criteria, treatment planning, continued stay criteria, 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.
- 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 that quantifies the appropriateness of treatment according to professional and regulatory standards of care.
- A team of experienced and licensed clinicians and administrators.
Review bios of some of our Clinical Experts:
OMIG Audit Support and Appeals
SAE & Associates 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.
- a standardized OMIG protocol assessment utilizing our scoresheet methodology to review case records (in both written and electronic formats) according to reported deficiencies.
- 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 solutions of the clinical, administrative, and technological elements 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 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:
- Stabilization and Withdrawal;
- Comprehensive Psychiatric Emergency Programs (CPEP);
- Outpatient Clinic;
- Partial Hospitalization; and
- Personalized Rehabilitative Oriented Services (PROS).
SAE has the experience and expertise in the development of these licensed programs, and 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 will include a Needs Assessment based on the behavioral health needs of the population in the proposed service area, and will include a description of the Functional Program of the proposed programs.