URAC PCHCH Auditors Certification

Posted on June 29, 2012 by Linda Ringquist

One of the certifications offered through URAC is the URAC PCHCH Auditors Certification. PCHCH stands for patient centered health care home accreditation. Please see our spotlight services blog which defines PCHCH and emphasizes how BHM Healthcare Solutions can assist you with achieving PCHCH accreditation.

According to the URAC website, PCHCH Auditor Certification is intended for entities whose responsibility lies in external verification of the degree of successful implementation of the patient centered health care home by clinician-led health care practices. URAC’s PCHCH Auditor Certification uses national standards evaluated and approved by broad-based stakeholder process involving over 60 participants representing medical and nursing practice, case management, consumer organizations, payors, and providers. URAC PCHCH standards provide the essential foundation for payors, patients, and providers to collaborate in enhancing quality health care services across the continuum through shared accountability in a patient centered health care home.

URAC’s PCHCH Auditor Certification is offered to health management organizations desiring to provide independent PCHCH practice assessment audits of health care practices. URAC’s PCHCH Auditor Certification provides assurance to health care practices that their auditors are licensed, qualified and specially trained health care professionals who understand the complexities of care coordination. The URAC PCHCH Auditor Certification requires URAC Core accreditation, assuring that the auditing organization meets desirable standards of operation and quality management prior to performing practice audits. URAC provides the certified auditor with access to and training on tools that support verification that a practice successfully meets a baseline percentage of select URAC PCHCH essential standards. Auditors also obtain the tools and capabilities to validate practice performance on any additional URAC PCHCH standards required by a payor as a component of a quality pay for performance program.

URAC’s PCHCH Auditor Certification is offered to health care organizations, health plans and consulting companies desiring to provide independent PCHCH practice assessment audits to health care practices and uses URAC’s Core Module Standards, assuring that the organization meets specified standards prior to performing PCHCH practice audits.

URAC’s PCHCH Auditor Certification includes:

Core Accreditation Standards v 3.0
URAC’s PCHCH Primer – an electronic tool for comparative analysis of practice performance with the URAC
URAC PCHCH standards
3 year core accreditation with URAC PCHCH Auditor Certification
Auditor licensure and training eligibility requirements
URAC issued practice audit tool and observation validation prior to achieving URAC PCHCH Auditor designation
Mid-cycle monitoring onsite
HIPAA Business Associate Requirement
Auditor Inter-Rater Validation of URAC issued Practice Audit Tool

BHM Healthcare Solutions is currently working toward URAC PCHCH Auditor Certification. Our accreditation survey is scheduled for July 2012. URAC PCHCH Certified Auditors are able to provide URAC PCHCH auditor services through the provision of independent PCHCH practice assessment audits for health care practices.

Part 2 of 2 – New CARF Standards Effective for Surveys Conducted After June 30, 2012

Posted on June 28, 2012 by Linda Ringquist

Original source is from the CARF website

The Commission on Accreditation of Rehabilitation Facilities International (CARF) was founded in 1966 and serves the following areas: aging services, behavioral health, business and services management networks, child and youth services, employment and community services, and medical rehabilitation. Their mission is “to promote the quality, value, and optimal outcomes of services through a consultative accreditation process that centers on enhancing the lives of the persons served.” CARF is constantly updating their policies and practices to keep up with the ever-changing world or Rehab. Thus far in 2012, the following four initiatives have been announced:

Case management standards to Aging Services accreditation area
Accreditation for supported education in 2012 Employment and Community Services Standards Manual
Accreditation for independent evaluation services in 2012 Medical Rehabilitation Standards Manual
Accreditation for student counseling in 2012 Behavioral Health Standards Manual

This current blog is a continuation from our previous and focuses on evaluation services and student counseling. Please refer to Part 1 – New CARF Standards Effective for Surveys Conducted After June 30, 2012 to be updated on additional new standards which will affect surveys conducted after June 30, 2012.

Independent evaluation services coordinate unbiased evaluations based on individualized referral questions, effective use of resources, and relevant communication with stakeholders. According to Christine McDowell, managing director of CARF’s Medical Rehabilitation accreditation area, “Both service providers and insurance companies urged CARF to review the independent evaluation services field to ensure consistency of practices and also to address the unique needs of the populations the providers and insurers serve. Independent evaluations may be completed by one or more healthcare professionals who are not involved in the care of the person served for the purpose of clarifying clinical case issues.” These standards will apply to surveys conducted after June 30, 2012.

Student counseling programs serve as the primary behavioral health resource for higher education campus communities and their students. Services include: individual, family, and/or group counseling, prevention, education, and outreach. The accreditation standards were drafted as it became evident that a growing number of mental health centers were contracting with university systems to provide their student counseling services. According to Nikki Migas, managing director of CARF’s Behavioral Health accreditation area, “The student counseling standards are designed to provide students with opportunities to develop personal insight, identify and solve problems, and implement positive strategies to better manage their lives both academically and personally. In addition to working directly with students, program goals can be realized through outreach, partnerships, and consultation initiatives with faculty, staff, parents, students’ internships sites, or other educational entities or community partners.” These standards will apply to surveys conducted after June 30, 2012.

BHM Healthcare Solutions is one of the top healthcare consulting firms in the country. One of our many areas of expertise is CARF accreditation. Our CARF accreditation consultants always stay abreast of any regulatory changes and are experts in helping our clients obtain or renew accreditation status. If you are in need of CARF accreditation consulting, please contact us by calling 1-888-831-1171.

BHM Healthcare Solutions Services Spotlight – Patient Centered Health Care Home Accreditation

Posted on June 27, 2012 by Linda Ringquist

BHM Healthcare Solutions (BHM) specializes in healthcare management consulting. Our services are designed to help our clients achieve their goals by aligning and optimizing their growth, operational, financial and quality strategies. Our health care consultants bring a collaborative, knowledge based, and broad building style to every project resulting in measurable outcomes.

BHM clients have a 100% success rate in gaining the accreditation that their organizations sought. Need we say more? Our success rate speaks for itself.

Our last services spotlight focused on URAC accreditation in general. Today, we are focusing on Patient Centered Health Care Home Accreditation. According to the URAC website, “A Patient Centered Health Care Home (PCHCH) is a quality-driven, interdisciplinary clinician-driven approach to coordinating and delivering care that puts patients, family members, and personal caregivers at the center of all decisions concerning the patient’s health and wellness.” This basically means that any decisions made about a patient’s condition will be a collaborative effort between the patient, the patient’s family and the caregiver to arrive at the optimal method of treatment. Why shouldn’t the patient have input into their own care plan? Previous health care models centered around the caregiver’s recommendations without the input of the patient.

BHM understands how complex the accreditation process can be for healthcare organizations who are pursuing accreditation or re-accreditation, and our valuable guidance can serve to breakdown and simplify the complex and ever-changing components of URAC PCHCH accreditation into more management tasks in order to optimize your organization’s achievements.

Achieving URAC PCHCH Accreditation (sometimes called URAC Medical Home Accreditation) is an essential step for patient centered health care homes who wish to show they are nationally recognized for quality of care and meeting applicable standards. Accreditation also adds value to programs by providing an external seal of approval, and by promoting quality improvement within the organization as part of the accreditation process. The essential accreditation steps include:

Assessment of documentation compliance to URAC standards provided through analysis
Expert assistance and guidance toward URAC PCHCH compliance
Assembly of application and assistance with Accredinet
Content development and policy and procedure construction in an approved URAC format
Mock surveys
Specialized assistance with program design, orientation, and training

BHM can continue to work with your organization after accreditation is achieved. Accreditation is an ongoing process and our consultants can help keep your organization current with changing standards and procedures in your field. In the fast changing filed of healthcare, we can assist you now and in the future to ensure that your organization meets and stays within compliance. For a free consultation, please call 1-888-831-1171.

Part 1 of 2 – New CARF Standards Effective for Surveys Conducted After June 30, 2012

Posted on June 26, 2012 by Linda Ringquist

Original source of information is the CARF website. The Commission on Accreditation of Rehabilitation Facilities International (CARF) was founded in 1966 and serves the following areas: aging services, behavioral health, business and services management networks, child and youth services, employment and community services, and medical rehabilitation. Their mission is “to promote the quality, value, and optimal outcomes of services through a consultative accreditation process that centers on enhancing the lives of the persons served.” CARF is constantly updating their policies and practices to keep up with the ever-changing world or Rehab. Thus far in 2012, the following four initiatives have been announced:

Case management standards to Aging Services accreditation area
Accreditation for supported education in 2012 Employment and Community Services Standards Manual
Accreditation for independent evaluation services in 2012 Medical Rehabilitation Standards Manual
Accreditation for student counseling in 2012 Behavioral Health Standards Manual

This current blog will focus on case management standards and supported education. The following blog will focus on independent evaluation and student counseling.

According to the director of CARF’s Aging Services accreditation area, “Many aging services organizations offer home and community services for diverse populations that continue to reside in their own homes. Case management accreditation provides standards for delivering high quality services that assess consumer’s individual needs, refer them to the appropriate services, and arrange or coordinate their care.” These standards are now being extended to case management and are already a part of other areas which CARF accredits. Aging organizations can choose to become accredited in case management but not required. Organizations that manage the care of people in assisted living facilities, long-term care settings, or continuing care retirement communities are not required to add these standards to their existing accreditation. The effective date of the case management standards is surveys conducted after June 30, 2012.

Supported education refers to the postsecondary education of people with disabilities. The purpose is to support individuals who are enrolled or want to enroll in an education program to achieve their educational goals. According to Paul Andrew, managing director of CARF’s Employment and Community Services accreditation area, “Supported education expresses the belief that persons with disabilities can attend classes, learn and improve their options. Individuals with postsecondary degrees or certificates can enjoy the benefits of higher levels of earnings and savings, increased personal and professional mobility, improved quality of life for their children, and more job and career choices.” These standards will apply to surveys conducted after June 30, 2012.

Please return to our website to view part 2, the conclusion of the new CARF standards effective for surveys conducted after June 30, 2012. These will include: Accreditation for independent evaluation services in 2012 Medical Rehabilitation Standards Manual and Accreditation for student counseling in 2012 Behavioral Health Standards Manual.

The History of URAC

Posted on June 22, 2012 by Linda Ringquist

Original source is the URAC website

URAC is an independent, nonprofit organization designed to promote health care quality through mediums such as accreditation, education and measurement programs. URAC provides benchmarking services which provide a symbol of excellence for organizations to validate their commitment to quality and accountability.

URAC’s mission statement is very simple and straight-forward.” To promote continuous improvement in the quality and efficiency of health care management through processes of accreditation and education.”

In the 1980’s, there was an awareness and concern looming over the lack of uniform standards for utilization review services. Utilization review is defined as the process of organizations making a determination of whether or not a health care service is medically necessary. As a result of this growing concern, URAC set out to improve the quality and accountability of health care organizations using utilization review programs. Many years later, the goal of URAC expanded to cover a larger range of service functions found in health care settings, including the accreditation of integrated systems such as health plans to smaller organizations offering specialty services. Today, URAC accreditation and certification includes over 25 programs.

URAC was setup as an organization independent of any particular stakeholder group. The governing Board of Directors was established with representatives from affected groups such as consumers, providers, employers, regulators, and industry experts. Today URAC consists of more than 300 volunteers and 30 paid staff.

URAC is considered one of the fastest growing health care accreditation agencies world-wide. URAC is constantly reviewing and developing new standards to ensure that all stakeholders are protected.

With the importance and notoriety of URAC accreditation, BHM Healthcare Solutions provides URAC consulting services. A few our areas of expertise are: URAC PCHCH certified auditors, patient centered health care home accreditation, and URAC medical home accreditation. For additional information, please contact BHM Health Care Solutions at 1-888-831-1171 for a free consultation.

BHM Healthcare Solutions’ Service Spotlight – URAC Accreditation Assistance

Posted on June 21, 2012 by Linda Ringquist

BHM Healthcare Solutions is a healthcare management consulting firm serving health care enterprises nationwide. BHM stands for behavioral health management and as such is our area of expertise in healthcare consulting. Some of the services we provide include, but are not limited to, financial improvement, denial management, revenue cycle, physician advisor services, clinical operations/improvement, quality improvement programs, accreditation, behavioral health executive recruitment /interim staffing, and training. Our extremely competent team of healthcare management consultants is composed of experts in our field and we possess a wealth of knowledge and experience which we would like to share with you.

Today’s spotlight features our URAC accreditation assistance service. BHM has a 100% accreditation achievement success rate. URAC stands for Utilization Review Accreditation Commission. URAC is the largest accrediting body for healthcare and has accreditation programs which operate in every state. Attaining URAC accreditation can be an overwhelming task. Our team of URAC consultants provides services which range from strategic assistance throughout the process to completely guiding your organizational efforts. We can create a plan that is specific to accomplishing your goals.

BHM understands the complexities faced by healthcare organizations who are seeking accreditation, and our valuable guidance services can serve to break down the complex components of URAC accreditation into more management tasks in order to optimize your organization’s achievements.

BHM has successfully assisted dozens of organizations gain national accreditation and through this experience has honed the process so that it is maximally efficient and cost effective for your organization. Our unique process begins with a detailed analysis cross comparing the standards with organizational policies and procedures. This is an important step in determining how far your organization needs to go in order to achieve accreditation and which areas can be strategically targeted for improvement. Our URAC consultants can review all documentation to ensure that it meets standards, complete any necessary paperwork, and develop templates to be submitted in the preferred URAC format. Additionally, our consultants can assist you in navigating through Accreditnet, URAC’s software system. To make sure that all organizational members are fully prepared, we finalize preparedness with a mock audit exercise that will walk you through the onsite visit.

Additionally, we offer URAC accreditation assistance in patient centered health care home accreditation, URAC Medical Home Accreditation, and URAC PCHCH auditors certification. These will be the focus of our next service spotlight. For more information, please visit our accreditation webpage as well as our URAC-specific accreditation page. Please contact us today to setup a free initial consultation to see how we can assist you with your URAC accreditation consulting needs by calling 1-888-831-1171.

CMS Renews URAC’s Deeming Authority as Accreditation Organization for Medicare Advantage HMOs and PPOs

Posted on June 20, 2012 by Linda Ringquist

Original article may be found on the Urac website

The Department of Health and Human Services’ Center for Medicare & Medicaid Services (DDHS) announced in May 2012 the approval to renew the Medicare Advantage “deeming authority” of URAC for HMOs and PPOs from May 26, 2012 to May 25, 2018. “Deemed status” is official recognition by the nation’s largest third-payer (Medicare Advantage plans) that URAC accreditation meets and ideally exceeds CMS’ own regulatory standards for plan quality for both Medicare Advantage HMOs and Medicare Advantage local PPO in the following six areas:

Quality assessment and improvement
Access to services
Provider participation
Advance directives
Information about anti-discrimination
Confidentiality and accuracy of enrollee records

URAC’s Health Plan Accreditation program is a widely renowned symbol of excellence in the commercial arena, and through the Medicare Advantage Deeming Program, that mark of excellence is now extended to plans in the Medicare arena. URAC’s CMS “deemed status” streamlines the accreditation review process in one survey which encompasses both commercial and Medicare plans. No additional visits are required. It is like one-stop shopping.

URAC promotes health care quality through its accreditation, education and measurement programs. URAC offers a wide range of quality benchmarking programs and services that enable URAC to remain on the cutting edge of the ever-changing health care system and provides a symbol of excellence for organizations to provide quality and accountability measurements.

BHM Healthcare Services is healthcare management consulting company with one of our areas of expertise being URAC accreditation. Two of our sub-specialties are: URAC PCHCH auditors certification and URAC medical home accreditation. To setup a free consultation, please contact us 1-888-831-1171.

Recommendations for Measuring Cost, Utilization and Quality in the Medical Home

Posted on June 19, 2012 by Linda Ringquist

Original source is URAC website

Medical home programs need to be able to provide valid, measurable data in terms of outcomes as the medical home idea continues to be fine-tuned to assist in addressing the fragmentation of care, poor quality and high costs throughout the healthcare system.

Segments of the medical home have been associated with higher quality and lower costs. Many initiatives are circulating throughout the country including commercial health plans, individual state, and federal initiatives.

The ability to evaluate and compare results of these programs will assist payers, providers, states, and local government in the implementation of the medical home and similar initiatives. As of today, no standard, basic measures or metrics are available to evaluate these programs.

A new report from the Commonwealth Fund tries to do just that, by describing the process and recommendations of more than 75 researchers who came together to identify a core set of standardized measures to evaluate medical homes. The report focuses on the two major areas of medical home outcomes – cost and utilization and clinical quality.

According to the Commonwealth Fund report, the following are recommended principles and measures for assessing clinical quality in medical homes:

Evaluators should use standardized, validated, nationally endorsed measures.
Evaluators should select measures from each of the following areas of primary care: preventive care, chronic disease management, acute care, overuse, and safety.
Evaluators should apply a validated approach to data collection. This is particularly important if pulling measures from the medical record or electronic health record.
Evaluators should use consistent measures across practices within a demonstration.

BHM Healthcare Solutions is one of the top healthcare consulting firms in the nation. One our areas of expertise is URAC accreditation with subspecialties in URAC Medical Home Accreditation, URAC PCHCH auditors certification. Please call today to setup a free consultation. 1-888-831-1171.

Healthcare Reform and the Presidential Election

Posted on June 18, 2012 by Linda Ringquist

Original source is “The Hill” Healthwatch Blog

Healthcare Reform is a buzz word in terms of the upcoming presidential election. Three new articles were added to the website just since yesterday regarding this issue.

Obama Issues Veto Threat for Healthcare Bill

June 6, 2012, the White House threatened to veto a GOP-backed healthcare bill set for a House vote tis week. Republicans argue that H.R. 436, which would repeal the reform law’s medical device excise tax, would additionally lower healthcare costs. The White House said the measure “would fund tax breaks for industry by raising taxes on middle-class and low-income families” and increase the number of uninsured Americans. “The medical device industry, like others, will benefit from an additional 30 million potential consumers who will gain health coverage under the Affordable Care Act starting in 2014”, read the statement of administration policy. “This excise tax is one of several designed so the industries that gain from the coverage expansion will help offset the cost of that expansion.” In addition to repealing the device excise tax, the GOP bill will allow health care savings accounts to expense over-the-counter drugs and make it easier to utilize unused balances in these accounts. This bill is expected to see a floor vote on June 7 or June 8, 2012.

Romney: Obama “Knowingly” Held Back Economy to Pass Healthcare Reform

Mitt Romney alleged on June 6, 2012 that President Obama purposely slowed down the economic recovery to focus on healthcare. Romney stated “The idea that they knowingly slowed down our recovery in order to put in place Obama Care – which they wanted and they considered historic, but the American people did not want or consider historic – is something which I think deserves a lot of explaining.” Romney went on to say that Obama and his advisors discussed “the fact that Obamacare would slow down the economic recovery in this country, and they knew that before they passed it.”

Sebellius: “We’ll be ready if Supreme Court Strikes Healthcare Law”

Kathleen Sebellius, Health and Human Services Secretary said she is confident the Supreme Court will uphold the law but has a contingency plan should it not be upheld. The decision on this issue is expected to be rendered by the end of June 2012. A report last week stated that in private, President Obama expressed concerns that he may have to revisit the healthcare issues during his second term. This statement contradicts his views he has expressed publicly. According to Sebellius, she is gearing up for 2014, the time when some portions of the law are due to become effective. She also stated, “It’s best to anticipate the law is fully constitutional.”

Healthcare laws and regulations are changing at a rapid rate. Healthcare compliance and healthcare accreditation are affected by these changes. BHM Healthcare Solutions is one of the leading healthcare consulting firms. For more information, please visit our accreditation page and contact our health accreditation consultants 1-888-831-1171.

BHM Healthcare Solutions assists Crossroads Behavioral Health with URAC Accreditation

Posted on June 12, 2012 by Danyell Jones

URAC PCHCH Accreditation Summary

Crossroads Behavioral Health was recently awarded a 3-year URAC Accreditation for Health Network, Health Call Center, and Health Utilization Management. BHM Healthcare Solutions, a comprehensive healthcare management consulting firm, provided assistance to Crossroads that was pivotal in reaching accreditation success. URAC is the largest accrediting body for healthcare organizations and is recognized nationwide. URAC Accreditation is a symbol of excellence and validation for an organization’s commitment to quality and accountability.

Crossroads Behavioral Health LME serves the citizens of Iredell, Surry and Yadkin counties in North Carolina who need professional help for mental health, developmental disabilities or substance abuse treatment. This LME understands those individuals served should have the opportunity to reach their potential for living, learning and contributing to their communities. Further, the Crossroads team recognizes that personal and family difficulties are often stressful, and consequently the whole organization strives to make accessing behavioral healthcare services a smooth, reassuring experience.

BHM’s URAC Accreditation Assistance Team conducted a thorough review of Crossroads’ existing policies, procedures, program descriptions, reports and other data against the URAC standards. After developing a detailed project plan, the BHM consultants collaborated with members of Crossroads every step of the way to develop operational change where necessary in order to ensure that the organization was ready to meet the goal of accreditation with great efficiency and minimal cost. “We are so pleased to have assisted Crossroads Behavioral Health reach their goal of accreditation,” states Mark Rosenberg, President of BHM. “Crossroads has long been committed to a quality service delivery system,” he continued, “and we know that the new URAC Accreditation substantiates their pledge of excellence in the provision of behavioral healthcare services.”