Wednesday, 15 August 2018

How to Overcome the Unique Challenges of Assertive Community Treatment (ACT) Billing

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Assertive Community Treatment (ACT) offers hope for clients with severe and persistent mental illness, especially those who have not responded well to other treatments. ACT’s team-based, interdisciplinary approach may include medical treatment as well as vocational assistance, rehabilitation, family education, life skills training, and community support. The goal is to provide a bundle of coordinated services that fully address a patient’s wide-ranging needs.

While ACT can be a powerful treatment option, it does present an array of billing challenges. Because ACT involves more services than typical behavioral health/substance abuse treatment, it involves more providers (with a variety of licensing requirements) service locations, vendors, and reporting and compliance rules. Most ACT recipients see at least three team members in a month, according to New York state’s guidelines. Team members may include a psychiatrist, substance abuse counselor, nurse(s), program specialist, family specialist, and program assistant.

Practices that provide ACT must follow certification and billing procedures to maintain compliance and avoid reimbursement rejections. For example, ACT often requires the client’s chart be in compliance prior to billing. If the clinic bills for a client who is out of compliance, the clinic would fail an audit.

ACT often come with time requirements specific to this form of treatment. A certain number of hours – say three to six hours per month -- typically qualify the client for half-time billing, while more than six hours qualifies for full-time billing. Some plans do not allow clinics to bill for total appointment durations less than three hours within the month. In many cases, diagnostic summaries and treatment plans must be current to maintain compliance. Clinics must meet each payor’s requirements to avoid audit failure.

ClinicTracker can help. Our customizable, integrated EHR offers complex tools that allow you to easily track client compliance due dates and completion dates. You can even prevent performing appointments for clients that are out of compliance. Our Batch Create Claims feature lets you create a bundled claim based on the actual duration of appointments over a timespan.

We can help you create the workflow that matches your clinic’s unique staff and services, including ACT’s complex requirements. One of ACT’s hallmarks is creating individualized treatment that best serves the patient. With ClinicTracker’s tools, you can also individualize your office operations. That ability is central to our track record of making your clinic run as efficiently as possible, enabling you to focus on your patients’ success.

ClinicTracker is a robust, future-proof mental health and substance abuse EHR. Michael Gordon, a respected clinical psychologist, and Joshua Gordon, an award-winning software engineer, founded the company in 2000. ClinicTracker EHRs powerful software empowers your agency to succeed. ClinicTracker will automate many of your clinic routines, boost staff productivity, increase billing efficiency, and provide the tools you need to manage your clinic effectively. While mental health and substance abuse agencies are our main focus, our software is compatible with foster care agencies, social services, equine assisted therapy, university clinics, academic counseling, family counseling services, and eating disorder clinics.

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