Recently a local professional group noted that the Oklahoma Healthcare Authority had one of the lowest rates of payment errors in the United States. The OHCA https://www.okhca.org is an entity that monitors and manages outbound payments of Medicaid dollars for all services paid for by federal Medicaid monies given to Oklahoma by the United States government.
Today, in a meeting it was presented again that multiple mental health and addictions treatment providers sitting in a room were wholly or partially unpaid for services rendered to Oklahoma citizens under state approved agencies for mental health or addictions. Some were Medicaid and some were private insurance clients.
In Oklahoma, most agencies providing care as mental health and addictions services are privately held almost "mom and pop" operations.
Persons working at the agency are called professional providers/contractors. Privately held agencies may be owned by an individual, DBA ( group or individual who represents under one name, but is made up of other people or other groups than listed in the name or on business documents) or may be held by a private entity ( the Catholic Church or Planned Parenthood) or may be held by a corporation ( like UHS, United Health Services). http://okcommerce.gov/new-and-existing-business/starting-a-new-business/... It is not always clear who the business entity is who is running the counseling service.
The discussion today was whether that would occur to the consumer to ask ( who is this agency and why do they have a counseling service, what is their mission and is it client or revenue focused?) http://topnonprofits.com/examples/nonprofit-mission-statements/ and if consumers understand what happens with their dollars when they enter agencies for service.
A nonprofit is a group whose dollars go only to the function of the services, and there is no revenue generated above this money. And what is the difference between a non-profit and a not for profit. http://nonprofit.about.com/od/qathebasics/f/nopvspro.htm Does this effect care one gets for counseling , which is a very personal service that needs to be steady and reliable.
Agencies must hold a credential like CARF http://www.carf.org/home/ ( a regulation of a style of documentation and agency procedure, not quality of counseling care) or JCHAO http://www.jointcommission.org/ ( the highest regulation of an agency, often held by hospitals, but also only about procedure for running the business, managing records... and not a regulation or insurance of quality of service). So having one of these accreditations does NOT assure that an actual service provided will meet any particular criteria, or will be effective. Both CARF and JCHAO take into account complaints about a facility, but they have no power to address any corrective action. These groups are concerned with the structure of services to the consumer, and issues regarding Human Resources or even consumer complaints or staff complaints would be held in separate functions/files within the agency. The information doesn't meet up, and neither of these accreditations groups have any power to effect change if a problem were discovered or noted to them.
Agencies must also have a tax identification http://www.tax.ok.gov/ and a business license https://www.okc.gov/business/businesslicense.html. These two things also do not address this question along with the certification permit the agency to apply to bill for mental health and addictions services, through Medicaid or private insurances.
The meeting discussion today is that more and more agencies in mental health and addictions seem to be run by people who are business people, and not by people who are therapists. Some are DBA, where one does not know just who is the mysterious configuration behind the agency. One can learn, through the Oklahoma Tax Commission just who holds a DBA, but this has to be logged as a formal request, and there is a fee, which must be paid by a credit card in order to get information as to who it is.
Could it be that there is ALEC influence in mental health/addictions in Oklahoma ? http://www.youtube.com/watch?v=NXUPDAMc_6o. or http://www.examiner.com/article/which-switch-is-which-duplicitous-relati... where processes support other processes? Or that is too much of a stretch. http://www.examiner.com/article/counteracting-convenient-ignorance to Marian Wright Edelman's cradle to prison pipeline. Though that may be a stretch.
Ok. Back to OHCA does not guarantee payment to the provider. Period. And the client is never held financially responsible for non-paid hours from OHCA or a private insurance.
If a person running a business fails to a.) bill in a timely manner, b.) witholds dollars paid from OHCA to a provider or c.) does not turn payment directly from the OHCA to the agency to the provider, there are no Oklahoma work law provisions to recoup that money rather than the individual provider to file suit against the employer ( with their own money). Dollar amounts under $6000 cna be handled in a small claims court process. Higher dollar amounts require formal filings and representation by an attorney. Most Oklahoma professional contractors in mental health and addictions have been bilked in billing or contracting gaffs are out the higher dollar amount from one or more agency. Repeatedly.
So, this money not delivered to the provider/contractor is not tracked by OHCA, and not tracked by federal level Medicaid, unless there is a complaint filed with Medicaid. The money, if an error is discovered is not returned to the provider, but in these processes is recouped by Medicaid. The provider/contractor never gets paid and is not allowed to bill independent of an agency that has a contract with the OHCA for a service rendered under an agency.
So that is how many hours of free service donated to the state and federal government for care? Is anyone tracking this?
Oklahoma public or private employees (W-2) who are paid a wage and have a tax status with the employer, are eligible as a laborer to be protected in their work environment to some degree, and the verbal or written agreement will be upheld by the Oklahoma Department of Labor.
In Oklahoma, there are virtually no laws holding an agency to pay a provider/contractor. There is no process for the agency to be audited for their care of persons under contract or in their employ. Sleight of hand in changes in promises in original contracts, changes in pay rates, changes in pay dates and agencies who pay their administrative staff first and the provider/contractor late or never are not uncommon.
The agency owns the workproduct of the provider/contractor, so say the agency managed not to process billing on time for a comprehensive assessment done by a qualified provider. Comprehensive assessments (the client intake paperwork/workproduct) gtake days and multiple appointments to complete from face to face appointments. These may happen in an office or the provider/contractor may travel to the community to see the client. If the agency fails to properly process the claim inbound to OHCA, that is an initial gaff. The time frame in which billing can happen has to be related exactly, or the payment doesn't happen. So the papers, account to bill and data "expire" under the provider/contractor who signed the client into the Medicaid/OHCA service to bill.
But, the assessment still holds valid data.
Often, the provider/contractor will leave the agency due to non-payment, and then the assessment will be re-entered under another provider/contractor and then the agency will be paid. The first provider did the core work, the second provider/contractor got the financial credit. Assessments cost more than direct service counseling hours. sometimes, the agency owner is a clinician and they bill it themselves. One person can manage many clients in therapy, but doing multiple intakes takes hours to talk and write and complete the assessment and then the careplan ( goals of therapy) Individual therapy, group,family therapy, and behavioral rehab is a fraction of the skill, focus and effort.
You do the math. Remember, this is a pervasive practice.( it has happened to more mental health/ addictions providers than not).
There is no system locally or nationally that audits this performance problem of non-payment. Licensure boards for any kind of Oklahoma Counselor : LPC ( Licensed Professional Counselor, LADC (Licensed Addicitions Counselor), LCSW ( Licensed Clinical Social Worker ) or LMFT ( Licensed Marriage and Family Therapist) do not allow a provider/contractor to take professional licensing actions against a licensed person for bilking the provider/contractor. There is also no ethics regarding NOT paying peers or employees if you hold a professional license in Oklahoma. Including physicians, psychologists, neurologists and such. You can still practice, because it is not tracked, reported or confronted as abuse of employees. In helping professions. In a state that has a severe problem with active suicidality.
Billing practices like this make it so the provider/contractor is donating services. It ignores the sacred nature of the attachment clients make with a provider/contractor because the provider is forced to leave work circumstances, and often has signed a contract saying that the agency "owns" the client, the client file and the client billing.
Attachment is the super-personal connnection of trust that allows the client ( remember this is mental health and addictions and many of these people have had trauma abuse and abandonment issues. ) to trust the provider to share their life processes and secrets. The practice of splitting assessments in community services is also a disservice, where the client is forced to sit with an assessor and basically spill their guts, and then shuttled on to another provider for "care". In hospitals, this is relevant, as the hospital is open 24/7 and services have to happen in an expedited manner. In community services, this fragments care, and causes people to think that the system only wants them to fill out forms. Care is removed from care when it is handled this way. It is called systems induced trauma, and it is what happens to people in public social services, with the police and other places that also should not be handling the client in this way. It probably, actually contributes to fragmentation that makes it hard for clients to be identified as suicidal, and in the process of successfully preventing suicides
Many people who are providers/contractors are women. Many are single, head of household providers. Many have to work more than one job anyway, are under supervision towards a higher level of practice credential, or are students in the process of learning to be independent provider/contractors. Can this group of carers really afford to be marginalized? Is this really as pervasive as this group today discussed? How many thousands of dollars are mental health and addictions providers out in this system that plays them to the negative?
Recently in the Oklahoma City news was a local agency managed by a person who was an accountant.
This person, opened youth focused mental health/addictions agencies across Oklahoma. He understood that Oklahoma is a right to work state, and a person who is a professional contractor is not protected by the laws or governance of the Department of Labor. http://www.ok.gov/odol/.
As a condition of the new provider/contractor coming to the program, they must provide their own referrals INTO the system. The problems happened as above, where clients were processed through assessments and sometimes into a care process. Provider/contractors get a percentage of the dollars they bill for, so certain types of work pay at higher rates than others. This particular agency offered a very high percentage, 75% of all billing processes.
Since the agency often has a steady stream of employees and clients, it looks like the agency is popular and successfully providing services. No professional counseling group has called for changes. It appears things are all a 'go".
The person who runs such an agency does not have to have any kind of a contract with the provider/contractor that ensures payment. The person running billing does not have to prove competence, and does not have to respond to failures with any improvement in performance related to billing or the bigger issue of reimbursement. There is no protection for the provider/contractor, and no corrective standard and measure that would ensure improvements if an issue is discovered. IF the agency does this wrong act consistently, and gets reported, a percentage of the error will be caught. The caught error does not allow the provider/contractor to be paid.
It would be possible to discover how the provider population has been affected by this problem over the last 10 years, and how this has effected consumer services.
OHCA audits billing for inaccuracies, but this may merely result in the agency informing a provider after the fact ( billed and payment received and cashed) that they must then repay the OHCA. So whose error and responsibility is this? Billers are often high school educated, maybe have a bachelors degree. There is no credential or certification that anyone must hold to be allowed to be a biller for an agency. The provider/contractor is at the mercy of the agency and selected biller, who may work in, or out of the office.
The agency is not out money, as this exchange is often virtual dollars, though the provider/contractor may be dinked dollars on an actual paycheck. Agency non-billing is also not tractable, and so the provider/contractor may do the work, only to discover that no effort was made to bill, billing was mis-entered or billing was not resubmitted when errors in original billing were made, or co-payments or out of pocket deductibles were not properly collected. The provider/contractor has no recourse, other than to sue, which entails a need to access the records for service and billing which are privately held by the agency. You do the math.
This level of tight repayments on OHCA discovered errors is the focus of the boast about Oklahoma Medicaid having low errors in mis-mangaged Medicaid moneys.