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Common Behavioral Health Compliance Issues

man sitting on stairs looking thoughtful as he considers common behavioral health compliance issues

Staying compliant with evolving behavioral health regulations can be a challenge. Issues with documentation, billing, and treatment plans—along with medical necessity and ethics—may crop up for your organization. With the right electronic medical records management and continuous assessment of your quality of care, you can stay on top of addiction and mental health treatment compliance issues.

Why Is Addiction and Mental Health Treatment Compliance Important?

Behavioral health regulatory compliance is about more than just meeting a set of standards. Compliance is connected to quality of care and strong patient outcomes. When your operations follow state and federal guidelines, you’re more likely to meet patient needs in areas like privacy and safety. And reviewing your operations for compliance keeps your organization efficient and reduces the risk of errors.

On the other hand, non-compliance can have significant consequences. Failing to meet insurance company requirements may mean your facility is not paid. And breaching regulations in other areas may lead to fines and even loss of your healthcare license.

HIPAA Regulations and Patient Privacy

Protecting the privacy of patient information is one of the most frequent behavioral health compliance issues. Staff members need a solid understanding of the Health Insurance Portability and Accountability Act (HIPAA), which covers privacy, security, and enforcement. HIPAA compliance is crucial to addiction and mental health treatment, where patients share especially sensitive information with their doctors. A good electronic medical records (EMR) system will include techniques to maintain patient privacy, such as only granting certain members of staff access to a patient’s medical records and protecting personal health information.

Accurate and Complete Documentation and Correct Billing

Clinical documentation and coding errors can slow down your process considerably with denied insurance claims. Errors can range from illegible handwriting on a form to missing information on treatment plans and incomplete discharge summaries. Any error may cost you time and revenue.

Documentation requirements are also subject to change, so staying on top of them can be a hassle. An EMR system can automatically update your documents to fit changing compliance guidelines. EMRs may also include other built-in features to keep your documents up to code, like electronic signatures or medication administration records.

Compliance issues can surface if a patient is billed for services they didn’t receive or is billed an incorrect amount. Reviewing your billing system, and implementing a good EMR, can help you avoid costly billing mistakes.

Meeting Compliance Standards in Multiple States

For larger behavioral healthcare organizations that operate in more than one state, keeping track of different state regulations makes it challenging to maintain compliance. The compliance issues get more complicated if practitioners treat patients across state lines through telehealth or potentially practice care in a state where they aren’t licensed.

An EMR can build charts for different state standards and track each state’s requirements for different levels of care. The system also contains privacy controls to protect patient information that is transmitted to various providers.

Developing Strong, Precise Treatment Plans

Missing components in a treatment plan can turn into behavioral health compliance issues. Common mistakes include missing aspects of a psychiatric or psychosocial evaluation.

When you take time to standardize and review the assessments you give to patients, you make sure you cover every part of the required evaluation. You’re also ensuring that all the necessary information is available to provide each patient with the individualized treatment plan they need—with a precise diagnosis and measurable behavioral goals.

Other Common Behavioral Health Compliance Issues

Other addiction and mental health treatment compliance issues that you may encounter include issues related to the following:

  • Safety standards in inpatient environments
  • State and federal regulations surrounding telehealth
  • Proving the medical necessity of psychiatric admissions for Medicare and non-Medicare patients
  • Honest advertising in websites and other marketing materials
  • Complying with anti-referral laws, which prohibit providers from making referrals to organizations in which the provider has a financial interest or prescribing medications for which the provider receives compensation

Consistent review of your health care practices, education for your entire staff on compliance issues, and implementation of fraud detection strategies will go a long way toward managing the risk of non-compliance. Picking the right EHR for your practice is another critical step in keeping you compliant.

Sunwave Health: Your Partner in Compliance

Quality assurance is integrated into Sunwave’s software platform—a suite of services designed specifically for behavioral health organizations. Our EMR takes the work out of compliance. Our software automates the auditing of forms and charts, including signature approvals, so your documents remain compliant every step of the way. You’ll get an alert when important forms are due. And you can communicate easily with other staff members on the platform, so no vital information is lost in translation.

Compliance doesn’t have to be painful. Let us help your behavioral health organization do what it does best – treat patients. Learn more about our software by contacting us online.