1 Customer Service One to Another Developed by the NC DHHS-LME/MCO-Provider Collaboration Workgroup February 2014 Revised 3-4-14 Presented by: Margaret.

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Presentation transcript:

1 Customer Service One to Another Developed by the NC DHHS-LME/MCO-Provider Collaboration Workgroup February 2014 Revised Presented by: Margaret Mason COO, HomeCare Management Corporation Representing the NC Providers Council Carol Robertson QM Director, Sandhills Center for MH/DD/SAS Representing the NC Council of Community Programs

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4 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 ng/index.htm#tools ng/index.htm#tools

5 Develop and manage service benefit plans; coordinate and monitor services provided. Use DHHS Provider Monitoring Tools for agency audits ring/index.htm#tools ring/index.htm#tools Also completes fiscal and billing audits (Post- Payment Reviews). Reviews when complaints are received. Targeted/Focused Monitoring. Incident Report reviews.

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7 Greet and welcome Make introductions Demonstrate respect Be professional Be calm and friendly Discuss openly when there is disagreement

8 Ask questions. To share, without hesitation, if the review becomes too disruptive for the participants. Demonstrate integrity throughout the process. Ensure transparency.

9 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.

10 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.

11 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:

12 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.

13 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.

14 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.

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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. 16