1 customer service one to another developed by the nc dhhs-lme/mco-provider collaboration workgroup...
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Customer ServiceOne to Another
Developed by the NC DHHS-LME/MCO-Provider Collaboration Workgroup
February 2014
Revised 3-4-14
Presented by: Margaret MasonCOO, HomeCare Management CorporationRepresenting the NC Providers Council
Carol RobertsonQM Director, Sandhills Center for MH/DD/SASRepresenting the NC Council of Community Programs
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Customer Service One to Another
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Important Things to Remember:
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• Remain abreast of applicable policies, rules, regulations, standards and other information provided by the Division of MH/DD/SAS Administrative Publications and all other standards established by the Federal Government, State of NC or LME-MCO per contractual agreement.
• Comply with contractual obligations as denoted in individual contracts with respective LME-MCOs.
• Provide services as delineated in individual contracts with respective LME-MCOs.
• Use Provider Monitoring Tool for agency audits http://www.ncdhhs.gov/mhddsas/providers/providermonitoring/index.htm#tools
Providers
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• Develop and manage service benefit plans; coordinate and monitor services provided.
• Use DHHS Provider Monitoring Tools for agency audits http://www.ncdhhs.gov/mhddsas/providers/providermonitoring/index.htm#tools
• Also completes fiscal and billing audits (Post-
Payment Reviews).
• Reviews when complaints are received.
• Targeted/Focused Monitoring.
• Incident Report reviews.
Managed Care Organization (LME/MCO)
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General Monitoring Courtesies
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• Greet and welcome
• Make introductions
• Demonstrate respect
• Be professional
• Be calm and friendly
• Discuss openly when there is disagreement
Remember to:
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• Ask questions. • To share, without hesitation, if the
review becomes too disruptive for the participants.
• Demonstrate integrity throughout the process.
• Ensure transparency.
Remember to:
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• The process is not personal; it is a system – we all have shared accountability.
• Providers need to ensure preparedness, and LME-MCOs need to demonstrate patience, e.g. information may not be readily available and/or resources may be limited.
Other Reminders:
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• We must all work collaboratively.• Collaboration will ensure an effective,
efficient, and successful process.• Assume positive intent - monitoring is a
learning experience, not a punitive exercise.
• Be engaged in the information and dialogue.
Other Reminders:
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• Complete the survey as means to further improve the process.
• Most importantly, remember the primary objective is to ensure the health and safety of all the participants supported in the MH/I/DD/SAS system.
Other Reminders:
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• Ask questions when indicated.• Provide responses to questions.• Ensure responses are accurate and
to the point.• Stick to the question; do not talk
around it.
Asking and Answering Questions:
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• Responses should be referenced-based as needed.
• Make sure the question is understood in its entirety.
• Recognize the difference between “I think” and “I know.”
Asking and Answering Questions:
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•Efforts to resolve at the lowest possible level have proved ineffective.
•There is lack of professionalism.
•Actions are not in accordance with standard operating practices for the LME-MCO or Provider.
•There is continued disagreement concerning a particular issue.
•Additional support is warranted.
Seek Recourse When:
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Partners Making a Difference
Questions
If you have any questions about how the use the automated workbook and review tools, please send your questions to the Provider Monitoring mailbox:
Please include in the Subject line the nature of your question.
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