By Gary Humble | March 15, 2021

Preparing for Medicaid Managed Care Organization Clinical Audits

Nothing brings terror to the heart of an Executive Director than to hear that a Managed Care Organization (MCO) is coming to conduct a clinical audit! Remember, the MCOs are charged with among other things, to "bend the cost curve" for their client, The Ohio Department of Medicaid.  Their mission is to ensure that their [...]

By Gary Humble | March 3, 2021

Questions from the Field: Understanding How MarketPlace Products Work

From time to time, I receive some real good questions from the field on various administrative issues.  Here is a question I received recently regarding a client's MarketPlace product: Question: I have had a number of clients come in with individual policies only to discover that most of these payers were actually being offered by [...]

By Gary Humble | February 19, 2021

G&M Consulting Offers a CAQH Maintenance Subscription Service to the Behavioral Health Community

For most clinicians, administrative tasks are not what they went to school for!  They are interested in working with their clients and their clients' families. Unfortunately, administrative tasks are a fact of life in our practices and to neglect them invites revenue disruption! Many third party payers (both Medicaid and Commercial) have streamlined their credentialing [...]

By Gary Humble | January 15, 2021

Is Your Agency Exploring Contracting with Commercial Insurance Plans? Here are a Few things to Ponder!

Is Your Agency Exploring Contracting with Commercial Insurance Plans?  Here are a Few Items that should be on Your Punch List. Most Community Behavioral Health Centers (CBCs) have been focused on the administrative and clinical implementation of behavioral health carve services for their Community Medicaid Managed Care Plan (MCP) clients.  At the same time, many [...]

By Gary Humble | October 27, 2020

Making Lemonade out of Lemons: What New Opportunities exist after Our Organizations get through this Crisis?

What New Opportunities exist after Our Organizations get through this Crisis? I know all of our organizations have been scrambling in wake of this pandemic to meet the needs of our clients. Ohio Medicaid as well as many commercial payers moved quickly to accommodate TeleHealth services implemented by agencies around this State. As of this [...]

By Gary Humble | May 15, 2020

Is Your Organization Developing a Managed Care Mindset?

The smoke has cleared and Ohio's Behavioral Health Design initiative is now reality.  The new code sets, new Medicaid covered services and billing requirements are now in place.  Our system has now had approximately eighteen months to adjust to our new world.  But there is no rest for the weary! Behavioral Health agencies have a [...]

By Gary Humble | January 6, 2020

What Areas Should Your Organization be Focused at the Beginning of this New Year?

It's hard to believe that we are now almost 20 years into the "new" millennium! And, as we prepare for a new year, is your organization focused on your revenue cycle process to minimize any "hiccups" to cash flow going forward?  What are some time tested activities your administrative staff should be involved in now to make [...]

By Gary Humble | November 15, 2019

Managed Care Contracting: Beware of Unintended Consequences

OK!  You Are Now Contracted with Medicaid Managed Care Organizations (MCOs)!  So, Where does Your Organization Go from Here?! The dust has settled..... the Ohio Medicaid MCO credentialing & contracting frenzy is now a distant (or not so distant!) memory for many behavioral health agencies.  So where do you go from here? Much of your [...]

By Gary Humble | September 24, 2019

How Should Behavioral Health Practices Prepare for the Future: Understand the Trends!

As of this writing, we are almost three quarters through 2019!  Where does time go?!  As we continue to take care of clients and immediate issues that are in front us, do not forget about your business planning for 2020 and beyond. As a private practice, you and your team have seen its fair share [...]

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