Behavioral Health Care Consulting

ABH® offers behavioral health care consulting as part of a full suite of mental health management services. The Health Care Reform Act passed in March 2010 includes legislation that requires Medicare/Medicaid providers to develop compliance plans as a condition of enrollment as a Medicaid/Medicare provider.

ABH provides consulting services for functions including:

  • Organizational risk assessment: This service involves reviewing an agency’s policies and practices to identify risks for fraudulent billing
  • Claims & Chart Record Audits: This service can be provided as a one-time function or as part of an ongoing contracted service with a provider to ensure compliance with the agency’s compliance policies. Audits are performed to look for the following potential issues:
    • Up-coding: billing using a procedure code with a higher rate of reimbursement than the service(s) actually rendered
    • Unbundling: utilizing separate procedure codes for services typically reimbursed using a combined payment code
    • Services that are not medically necessary
    • Billing for services not rendered (as evidenced by lack of documentation to support the services performed)
    • Worthless services
    • Duplicate billing
    • Documentation quality
  • Development of compliance policies and procedures
  • Development of processes to evaluate and measure effectiveness of compliance policies
  • Development of an agency’s annual compliance work plan
  • Development and distribution of compliance updates and newsletters
  • Development of corrective action plans as needed
  • Office of Inspector General (OIG) website queries for all individuals employed by the agency to determine whether any employee is “excluded” from providing services to Medicare/Medicaid clients
  • A “Compliance Hotline” for agencies in which ABH provides consultative services to identify and investigate any possible compliance issues

Advanced Behavioral Health, Inc.

213 Court Street
Middletown, CT 06457

Phone: (860) 638-5309
Fax: (860) 638-5302