Teaching mental health providers how to navigate the managed care industry and increase cash flow

Posts made in December, 2013

Advent: The Servant King

Posted by on Dec 21, 2013 in Advent, Christians, Christmas, Church, Jesus | 5 comments

Advent: The Servant King

I love this time of year. There’s a buzz in the air and a sense of excitement as we get closer to Christmas and the coming new year. I love seeing the lights and decorations and the nativity scenes around town. I love to hear the Christmas music blaring on the radio. I love to hear the old standards such as O Holy Night and Go Tell It on the Mountain. But without a doubt on of my favorite songs is How Many Kings by Downhere. I love this song for many reasons. But the main reason I love the song is because it reminds me of the true reason we celebrate. We celebrate the fact that God came to dwell among us. He humbled himself to be among us. And he didn’t have to do it. Yet His love for us was so great, that he gave it all up for our benefit.

Phil 2-78

I think sometimes we don’t appreciate the humanity of Christ. During our lowest points we cry out and say “God, you just don’t understand.” But he does understand. He came to be a servant. He understands what it means to feel hunger and pain. He understands what it means to be humiliated. He understands what it means to be betrayed by a loved one. He understands what it means to be abandoned and alone. He understands what it means to have to swallow your pride and make sacrifices for the good of others. He understands what it means to be obedient. He understands that sometimes doing the right thing will cost you everything, even your life at times. He gets it.

Now that we know He gets it, what does that mean going forward? It means that just as Christ humbled himself, sometimes we need to show a spirit of humility with one another. Just as Christ can empathize with us, let’s show that same empathy. Just as Christ humbled Himself in service to others, let’s do likewise. Even though at any time during His journey here on earth, Jesus could have easily walked away, he stayed. Jesus knew what He came here to do and He did it. In the same way, we need to follow God’s purpose for our lives, no matter where it leads. And it will not always end with wine and roses. Sometimes it may end with a crown of thorns. Now that’s a happy thought.

Phil 2-911But let’s remember that Jesus’ story did not end at the Cross. It was only the beginning. Because Jesus was obedient til the end, His name has been exalted. We still speak of his Grace and Mercy today. So in closing, let’s remember that Jesus stepped down from heaven, and lived the life as a servant. In living the life of a servant, He showed what it truly means to be obedient. In that obedience, He made the ultimate sacrifice for us. Let us honor that sacrifice in how we  treat one another. If you happen to be reading this and you aren’t a Christian, the same grace that has been offered to me is available to you. There is nothing you can do to earn it. Jesus has paid your debt. All you have to do is accept the gift. Please accept it today.

***This post is apart of a series called Voices in the Desert. Click below to read more advent posts from a community of bloggers.***


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Mental Health: Is Numb the Same as Fine?

Posted by on Dec 9, 2013 in Addiction, Mental Health, Psychotherapy | 0 comments

ID-10067232Here’s some self disclosure. I am a huge Scandal fan and one of my favorite characters is Mellie, the emotionally starved first lady. On a recent episode, Mellie was giving some advice to a colleague on how to deal with the pain of infidelity. The one little gem that stayed with me was “Numb is the same as fine.” Is it really? Well let’s dig into this a little more.

When you’re getting your wisdom teeth pulled, or any dental work involving a drill, numb is fine. Actually, it’s preferred. Most surgeries involve some form of anesthesia. Doctors tend to work better when the patient is not screaming and writhing around in pain. That’s fine. Numbness is induced in those situations. But what about those times when it’s not induced? Such as when you suddenly can’t feel your arm? Or when you can’t feel your legs after an accident. Numb is not so fine in those situations. Numbness is often a sign that something is wrong and you should probably seek some help.

Now that we’ve talked about physical numbness, let’s go a little bit deeper. Is emotional numbness the same as fine? Emotional pain can be very debilitating when not handled properly. Numbness can be a defense mechanism, especially after a traumatic event. Have you ever seen someone seem to move on autopilot after the death of a loved one? After the initial shock, it’s almost as if they are doing everything possible to not feel just to get through the day. Have you ever known someone who struggles with addiction? When you really get to the core of why they are using, it’s usually to avoid some sort of emotional pain, a desire to feel nothing. To them, it is the same as feeling fine. But is that any way to live?

Numbness has it’s purpose. It is meant to be a temporary state to encourage healing. It’s meant to keep you functional to get through the trauma. The problem comes when that numbness is a permanent fixture. It’s ok to experience joy, sadness, love, loss, anger, grief or any other emotions in between. Having feelings and dealing with them tends to make for a richer life. Being numb feels like everything is a haze. It’s like the world around you is painted in various shades of grey. But truly feeling and acknowledging those feelings is like living in a world full of bright, bold colors. I don’t know about you, but I like bright, bold colors.

Now it’s your turn. Is numb the same as fine? Can you truly live and be numb at the same time? Drop your comments below

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

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Deal With Your Crap

Posted by on Dec 5, 2013 in Change, Coaching, Psychotherapy | 0 comments

ID-10044304As we near the end of another year, some things have come to my attention. There are a lot of people who are still dealing with issues from a very long time ago. It could be a past assault, an abuse situation, a broken heart, or somebody just plain did them wrong. But the new year is around the corner. With the new year comes a chance to start over. Starting over can be difficult and scary. But sometimes it’s necessary for growth. And that’s what we want in the new year, growth. 

Sadly, many will let this opportunity for growth pass them by. Why? Because they are still stuck on things that happened long ago and have never dealt with the issues that have been affecting them for years. They ruminate on it. They allow past hurts to ruin present relationships and opportunities. They’re growth is stifled because they are still licking old wounds. 

So here is my advice as the new year approaches. Deal with your crap. Seriously. If you are still stuck on things that happened when you were 5 and now you’re 35, that’s way too long. I’m not saying that people have not suffered serious traumatic events. But how long are you going to nurse those old wounds. How many relationships have you bailed on because you didn’t trust or thought you weren’t good enough? How many opportunities have you let slip through your fingers because you felt you weren’t worthy based on what someone said to you when you were 10. 

Now here’s a question to ask yourself: What do I gain by holding on to this pain? Really think about that. Is it a sense of security? Is it a belief that you won’t get hurt again? Is it that you gain attention by allowing others to feel sorry for you?  Think about it. Now here’s another question: Do I really want to change? You would be surprised how often the real answer is no. Being where you are is comfortable. It’s familiar. Change requires being uncomfortable and adjusting to the new. Change means venturing into the unknown. Change can also mean accepting the pain of past hurts, completing the grieving process, and choosing to no longer be held captive by them. But if you really want to change, what are you doing to seek it? And are you willing to get the help you need in order to change and grow? Don’t let next year be a repeat of this year.

If your issues are such that you need help in order to change, there is nothing wrong with that. If you want to start the process today, I’m available for consultations. Contact me at 321-800-8520 or at truechangelifecoach@gmail.com. I offer coaching and psychotherapy services. 

 

Image courtesy of Ambro at FreeDigitalPhotos.net

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HIPAA, Mental Health, and Managed Care

Posted by on Dec 3, 2013 in HIPAA, Managed Care, Mental Health, Psychotherapy | 0 comments

ID-100213905There is a labyrinth of regulations called HIPAA that mental health and medical professionals have to navigate in order to remain in business. The Health Insurance Portability and Accountability Act of 1996 was established to create standards related to the creation and maintenance of electronic health records. It was also meant to regulate how Protected Health Information is used. Here’s why this is important. If a patient is being seen for a medical or mental health issues, they need to feel confident in the knowledge that their information won’t be sent to their employer. Or what if the patient is going through a divorce and/or child custody hearings? How likely are patients to be honest with their doctor or counselor if there is constant fear that their PHI will become public knowledge.

In my experience, medical and mental health professionals are very diligent about protecting the confidentiality of the client. However, there is an exclusion in HIPAA that many mental health professionals and the general population is not fully aware. It’s called the Treatment Payment Operations (TPO) HIPAA Exclusion. The exclusion states that if a patient is using insurance, then he is allowing the insurance company to obtain information from provider and coordinate care. The key words being “if the patient is using the insurance.” This applies whether the mental health provider participates in the plan or not. If you are a mental health provider and you participate or are “in-network” with that patient’s plan, typically you have a contractual obligation to coordinate care with the insurance company. Out of network providers do not have the same obligation. However, managed care companies can refuse to pay due to a lack of information. Think of it in terms of getting a loan from a bank. If a long standing customer walks into a bank and asks for a loan, the bank will want certain information from the customer to see if they qualify. The customer can say “You don’t need that information. I’ve been a customer for years. Just give me the loan.” But the bank reserves the right to not grant the loan based on a lack of information. Or based on the information given, doesn’t meet guidelines for being granted a loan. Using insurance benefits works in much the same way. In order to receive reimbursement, the care has to meet the guidelines. In order to see if the care is meeting the guidelines, insurance companies may ask for additional information regarding the patient’s care including a treatment plan and a plan for discharge.

In my time working in managed care, I have heard objections that it’s a violation of HIPAA to request such information. Well, from the TPO exclusion, it is not. The key is that managed care companies require the minimal necessary information to make a decision based on HIPAA. Typically, this includes the diagnosis, the treatment plan, the progress, and discharge plan. Some companies require this information in writing while other require a telephonic review. But the overall goal of the review is to determine if the care is meeting the guidelines, not to deny benefits.

So if you are a mental health provider and you are in a situation that requires you to give a clinical review to the managed care company, remember that it does not violate HIPAA to do so. I would recommend that if your patient is using insurance, you inform them at the beginning of treatment that their insurance may ask additional questions regarding their treatment and that using insurance gives the insurance company the right to request the information. It is also advisable that you have a proper release of information on file as well. This protects both you and the client. Also remember that insurance companies are not required to share information with employers due to HIPAA as well.

If you’re a mental health provider and you have had trouble getting along with managed care companies, let me help you. Many mental health providers just don’t have the time to learn the rules of how insurance works and become frustrated due to not getting paid in a timely manner. I can help you navigate the managed care industry and increase your cash flow. For more info, contact me at 321-800-8520   Image courtesy of Stuart Miles at FreeDigitalPhotos.net

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