COVID-19 vaccine hesitancy is highest among the very populations most disproportionally affected by the pandemic. This includes communities of color as well as groups who are economically and socially disadvantaged. Perceptions and concerns regarding patients’ responses to getting the vaccine may discourage engagement in conversations that are essential to increasing vaccination rates. Outside of patients’ values, fears, and social norms, they have valid concerns and real barriers to getting the vaccine. Read more here.

Have your claims ever been audited by a Medicaid Health Plan? Does the thought of a claims audit make your nervous or are you confident you’ll pass with no issues? Our compliance team is offering a training for behavioral health providers to help assess how you might do in a claims audit. This one-hour training, with a follow-up Q&A session, will help you develop a plan to assess your readiness for a claims audit. We’ll cover the following topics:

• The Colorado Access Audit Program
  
• Assessing your documentation and claims (building your audit plan and tool)
  
• Common audit findings
  
• Where to get help/resources

Please join our compliance team for this informative training on Tuesday, June 29th from 12:00 p.m. to 1:30 p.m. Click here to register. If you have any questions, please email our compliance team at compliance@coaccess.com.

During recent audits, we have found many documentation errors when billing for outpatient therapy services. All documentation must be legibly signed, dated, and include the providers’ credentials/license as part of the signature. The credentialed signature is what validates the claim for payment and must be completed before you submit a claim for payment. 

Audited records that reveal signatures added after the payment date or with inadequate provider signatures will fail an audit and lead to recoupment of the overpayment. It is critical that those who bill for outpatient therapy are familiar with the technical documentation requirements listed in the Uniform Service Coding Standards Manual maintained by HCPF. You can find the latest version of this manual here.

We recently reviewed 90791 and H0001 assessment claims and noticed billing patterns that may be outside of billing compliance standards. Please note the following billing standards for 90791 and H0001 codes:

1. Only ONE 90791 or H0001 can be billed per assessment, even if it takes two sessions to complete an assessment
   
2. Assessments should be reviewed and updated when there is a change in the patient's level of care or functioning, and should not be billed more frequently

It is important to ensure billing compliance. If you have any questions, please email our quality improvement team at qualityimprovement@coaccess.com.

We regularly monitor provider documentation to ensure all participating providers who deliver substance use services meet quality documentation standards. Quality audit criteria is based on regulations, billing manuals, industry best practices, and other sources that support quality documentation. We developed a comprehensive training on the most up-to-date SUD documentation standards that includes:

• General documentation
  
• Assessment
  
• Treatment planning
  
• Psychotherapy progress notes
  
• Case management

This training is titled “Quality Improvement Substance Use Disorder Documentation Training” and can be found in our Learning Management System. Please contact your provider relations representative or send an email to providerrelations@coaccess.com if you have not yet signed up for access to the Learning Management System. If you have questions about the training, please send an email to our quality improvement team at qualityimprovement@coaccess.com.

This ECHO series offers clinically relevant topics for primary care providers who provide or are looking to build, expand, and improve care to preteens through young adults. Once completed, you will be able to evaluate and manage common conditions in adolescent reproductive health. Over the course of six sessions, the series will include an overview of adolescent reproductive health issues, best practices in adolescent contraception and common adolescent gynecology concerns. Six weekly ECHO sessions will be held virtually on Thursdays from 7:00 a.m. to 8:00 a.m. starting July 22nd and continuing through August 26th. Click here to register.

If you do not already have an oncology resource, Western States Cancer Research NCORP can help you or your patient find oncology practices that specialize in the possible cancer type they have. In a time of duress, a seamless referral for a patient can be of help. Click here for more information.