As pressures mount from state, county, managed care organizations and other regulatory organizations, we are now seeing greater numbers of requests for compliance reporting. Organizations are gearing up to respond to concrete quantitative demands from their payors. Meaningful use, as defined by the HiTech Act, is also having an indirect affect on behavioral health and substance abuse organizations. Although the clinical quality measures defined by meaningful use are more apropos to primary care organizations, behavioral health and substance abuse organizations are anticipating a similar track of measures that may emerge for their organizations. This direction is born out by increasing quantitative requirements imposed by payors, and organizations are developing tools that allow them to be prepared to meet these demands.
One class of compliance measures often imposed by payors are program-specific compliance measures that must be met to obtain the maximum allowable billable rate. An example would be a requirement to provide a face-to-face contact every 30 days to clients enrolled in a particular program. Organizations attempting to meet these demands have learned that a comprehensive set of management practices must be put into place in order to achieve the best possible results. These include tools that allow individual clinicians to track performance objectives for clients on their caseload, as well as tools to allow managers to monitor performance for their teams and isolate pockets of non-compliance to identify process improvement techniques.