1 Customer Service One to Another Developed by the NC DHHS-LME/MCO-Provider - PowerPoint Presentation

1 Customer ServiceOne to Another Developed by the NC DHHS-LME/MCO-Provider Collaboration WorkgroupFebruary 2014 Revised 3-4-14 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

2 Customer Service One to Another

3 Important Things to Remember:

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 http://www.ncdhhs.gov/mhddsas/providers/providermonitoring/index.htm#tools Providers

5 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)

6 General Monitoring Courtesies

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

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

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. Other Reminders:

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. Other Reminders:

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. Asking and Answering Questions:

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.” Asking and Answering Questions:

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. Seek Recourse When:

15 Partners Making a Difference 15

QuestionsIf you have any questions about how the use the automated workbook and review tools, please send your questions to the Provider Monitoring mailbox:provider.monitoring@dhhs.nc.gov Please include in the Subject line the nature of your question. 16