Nothing strikes fear into the heart of an Executive Director quite like the news that a Managed Care Organization (MCO) is coming to conduct a clinical audit!

It’s important to remember that MCOs have a mission: to “bend the cost curve” on behalf of their client—the Ohio Department of Medicaid. Their role is to ensure that Medicaid members receive timely, high-quality, clinically appropriate, and cost-effective care. In short, MCOs are not only partners in care delivery—they are also financial stewards of public Medicaid dollars.

What Should Behavioral Health Organizations Be Preparing For?

Forward-thinking agencies are already asking:

“What do we need to do now to prepare for the next wave of MCO expectations?”

A key answer? Be ready for clinical audits.

MCOs have now spent several years paying behavioral health claims, which means they’ve built robust analytics around key metrics like:

  • Length of stay

  • Successful discharges

  • Readmission rates

These metrics apply not just to prior-authorized services, but also to non-authorized services such as Case Management and SUD Intensive Outpatient Programs (IOP).

How does your agency compare to others delivering similar services?
Are you tracking and analyzing your own outcomes data?

Is Your Documentation Audit-Ready?

Another critical question:

Does your organization have a systematic approach to ensure your clinical documentation meets managed care standards across all service lines?

If not, now is the time to prepare.

How G&M Consulting Can Help

At G&M Consulting, we’ve built a trusted network of Subject Matter Experts (SMEs) who specialize in clinical documentation, particularly for higher levels of care such as:

  • SUD Residential Treatment

  • SUD Intensive Outpatient Programs (IOP)

Our SMEs bring extensive, hands-on experience helping providers improve documentation in ways that withstand the scrutiny of any MCO audit. We’re here to support you before the audit notice ever arrives.

Let’s Start a Conversation

If you think your organization could benefit from audit preparation support, I invite you to reach out:
📧 ghumblebehavioralhealth@gmail.com

As always, let us know how G&M Consulting can support your team in navigating the ever-changing behavioral health landscape.