DM & ADR, Inc - Beacon Health Options

GAC000772

DM & ADR, Inc

Behavioral Health Quality Review Final Assessment

Address: 1710 Commerce Road, Athens, Georgia, 30607

Assessors: Dorian Milam, RN; John Dury, LPC, LMFT, MAC; Natalee Fritsch, LPC

Records Reviewed: 10

Date Range of Review: 5/17/2021 - 5/18/2021

The Georgia Collaborative ASO, in partnership with the Department of Behavioral Health and Developmental Disabilities (DBHDD), believes in accessible, high-quality care that leads to a life of recovery and independence. The provider should note any recommendations as an opportunity for quality improvement activities. The review is intended to measure the quality of your organization's systems and practices in adherence to DBHDD policies and standards. The Overall Score is calculated by averaging the categories below.

Billing Validation

85%

Service Guidelines

100%

Overall Score 93%

Focused Outcome

Areas 95%

Assessment &

Planning 91%

Review Date: 08/06/2019 Review Date: 04/02/2018 FY20 Statewide Average

Overall Score

58% 65% 84%*

Billing Validation

8% 5% 76%

Focused Outcome

Areas 86%

84%

93%

Assessment Service & Planning Guidelines

74% 80% 88%

65% 93% 90%

*For reviews conducted July 1, 2019 through June 30, 2020, Quality Risk Items (where identified) were deducted from the Overall Score. Additionally, in response to the COVID-19 pandemic, Quality Reviews were postponed between March 16 through June 30, 2020. Therefore, caution should be made when comparing scores to this time period.

Review ID: 10882

The Georgia Collaborative ASO / Beacon Health Options

Page 1 of 9

Summary of Significant Review Findings

Strengths and Improvements: ? Due to the COVID-19 pandemic, this review was conducted remotely instead of on-site. ? The provider's Overall Score increased from 58% in the last Behavioral Health Quality Review (BHQR) held in August of 2019 to 93% for this review. ? The provider's Billing Validation score increased from 8% in the last BHQR to 85% for this review. ? The provider's Assessment and Planning score increased from 74% in the last BHQR to 91% for this review. ? The provider's Focused Outcome Areas score increased from 86% in the last BHQR to 95% for this review. ? The provider's Service Guidelines score increased from 65% in the last BHQR to 100% for this review. ? The provider has addressed the COVID-19 pandemic in the following way: Developed a "COVID-19 Medicaid Video Telehealth Dosing Agreement" in which the individual understands the "at-home opioid maintenance medication administration" and agrees to log-in into the secure video telehealth service at the designated daily timeframe. ? Records included documentation of a letter by the provider addressed to other identified medical professionals alerting them to the individual's treatment for Opioid Use Disorder with Methadone. The letter informs the other medical providers that the individual is aware "not to obtain outside controlled substances from other physicians while attending Medication Assisted Treatment" in order to ensure a safe and effective treatment outcome. ? The provider completed a separate strengths, needs, abilities, and preferences (SNAPs) assessment with the individual. This is a continued strength for the provider. ? The provider continued to utilize the "Quality of Life" scale and the "Tapering Readiness Inventory." This is a continued strength for the provider. ? Staff initialed and made comments on lab results. ? The Informed Consent for Telehealth/Telemedicine Services was thorough and detailed anticipated benefits, possible risks, etc. ? The Individualized Recovery Plans (IRPs) documented individualized whole health and wellness goals, objectives, and interventions. This is a continued strength for the provider. Examples included: "PC will educate patient on exercises and stretches to relieve pain." "PC will coordinate care with PCP and surgeon regarding care and post-op pain control." "Preregister for COVID vaccination."

Opportunities for Improvement: ? Please see the Billing Validation section for more information on the following: Nine claims were affected due to not having a valid, verified diagnosis on the date the service was provided. Seven claims were affected due to having a billing code that was different from the code billed. ? Please see the Assessment and Planning section for more information on the following: ? Co-occurring health conditions were not addressed on the Individual Recovery Plan (IRP) in one of seven applicable records. ? In seven of 10 records, the transition/discharge plan did not include a step-down service. ? Please see the Focused Outcomes Area section for more information on the following: No records included a psychiatric or other advanced directive or documentation that the individual declined to have it in their record.

Review ID: 10882

The Georgia Collaborative ASO / Beacon Health Options

Page 2 of 9

Billing Validation

Justified Unjustified Total

Medicaid $1,647.65 $294.83 $1,942.48

Total $1,647.65

$294.83 $1,942.48

The Billing Validation Score is the percentage of justified billed units vs. paid/billed units for the reviewed claims. Paid dollars are calculated based on

payer: Medicaid is the sum of paid claims; State Funded Services are Fee for Service and State Funded Encounters combined (State Funded Encounters is the estimated sum of the value of accepted encounters).

Standard Eligibility Standards Quantitative Standards

Reason No valid, verified diagnosis on date service provided Billing code is missing or different from code billed

# of Discrepancies 9 7

Billing Validation: 85%

Strengths and Improvements:

? The provider's Billing Validation score increased from 8% in the last BHQR to 85% for this review. ? The following were noted improvements since the last BHQR (8-2019):

All records contained a current order for services as required. In all progress notes, documented interventions were related to the IRP. Examples included

documentation of Opioid Maintenance as well as Individual Counseling being documented on the IRP. All progress notes included the number of units billed.

Opportunities for Improvement:

? Nine claims were affected due to not having a valid, verified diagnosis on the date the service was provided. In one record the last verified diagnosis was dated 1/23/2020.

? Seven claims were affected due to having a billing code that was different from the code billed. In all examples, the billing code documented was H0020 GT; however, the code billed was H0020U4U6.

Review ID: 10882

The Georgia Collaborative ASO / Beacon Health Options

Page 3 of 9

When all responses to a question are "Not Applicable", no percentage is displayed.

Assessment & Planning: 91%

Strengths and Improvements:

? The provider's Assessment and Planning score increased from 74% in the last BHQR to 91% for this review. ? All IRPs reviewed included interventions that were goal-linked and service-consistent, an improvement since the

last BHQR (8-2019). ? All records contained a current behavioral health assessment of needs. ? All records contained a current medical screening. ? All individual's records contained IRPs which were individualized. ? Whole health and wellness goals were noted in all records. Examples included Human Immunodeficiency Virus

(HIV) and Hepatitis education. This is a continuing strength for the provider.

Opportunities for Improvement:

? One of 10 records did not contain a valid, verified diagnosis. In the one example, the last diagnosis was dated for 1/23/2020.

? In seven of 10 records, the transition/discharge plan did not include a step-down service. In the majority of examples, the transition plan stated that the" individual will transition from services when the individual has met all goals". This is a continued area for improvement, noted during the last BHQR (8-2019).

Review ID: 10882

The Georgia Collaborative ASO / Beacon Health Options

Page 4 of 9

Focused Outcome Areas

Rights 78%

Choice 100%

Whole Health 100%

Safety 100%

Focused Outcome

Areas 95%

Community 100%

Person Centered Practices

100%

Focused Outcome Areas: 95%

Strengths and Improvements:

? The provider's Focused Outcome Areas score increased from 86% in the last BHQR to 95% for this review. The following were improvements over the last BHQR (8-2019): All records contained a signed safety plan. All applicable records contained documentation that demonstrated the plan was reassessed based upon changing needs or circumstances. In all examples, changes in methadone dosage were made due to the response of the individual being served. In all records, documentation reflected that informed choice drove the selection of any housing options. Nursing Assessments in all records included assessing and monitoring individuals' response to medication(s), determining the need for a medication review, and the individual's medical and health issues. Nursing Assessments in all records included providing education to the individual and the family/ significant other(s) regarding nutritional, medical, and other health issues, and side effects of medication. Documentation in all records supported that the individual is being trained in self-administration of medication or that individual is unable to self-administer.

Opportunities for Improvement:

Rights

? No records included a psychiatric or other advanced directive or documentation that the individual declined to have in their record.

Review ID: 10882

The Georgia Collaborative ASO / Beacon Health Options

Page 5 of 9

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