How to Set Up Your SUD Center's QA Process

By Zach Rosen (CEO, Brellium) and Matt Michaels (CEO, BHA Compliance)

Introduction

Brellium helps dozens of mental health and substance use centers automate their chart review with AI. BHA Compliance helps mental health and substance use centers build robust Quality Assurance programs. Together, we've seen almost every derivation of how mental health and substance use centers handle QA.

In this guide, we'll outline how to most efficiently set up your quality assurance process for your behavioral health clinic.

Why QA is Important

1. To make sure your patients are being treated correctly and according to your clinical standards.
2. To make sure that every dollar your payers pay you stays in your pocket, instead of being clawed back months down the line.

In short, good QA = you sleep well at night.

Step 1: Setting Up Your Note Template

Good note template = way less time spent on auditing. It's essential to strike a balance between creating preset automated options and free text sections.

Recommendations for automation:

• Session info should be populated by your EMR rather than your providers
• Make sure your assessment, progress note, and group session templates have the appropriate elements to meet payor, accreditation and state requirements
• Making your goals easy to import is super important for getting billable session notes
• Sections like clinical techniques and interventions can be encoded into a checkbox section
• Use automated e-signatures if possible

Recommendations for free text:

• Session narrative: Your clinical staff need to be able to clearly communicate what happened in the session
• Additional Notes: Edge cases happen. It's important that your providers have the opportunity to explain any exacerbating or unusual circumstances

Step 2: Outlining Clear Rules for Your Providers

Your QA process is 50% setting up a great session note template and 50% training your staff well. The key is to have a go-to person within your organization that your providers and QA staff can ask questions to.

Give your providers training examples for what a good note looks like. Outline exactly what should be noted in each free text section using tool tips, training guidance, or cheat sheets.

Step 3: Setting Up Your Audit Requirements

Make sure your audit criteria are actual insurance, accreditation, or state requirements. Differentiate your criteria between clear cut technical audit requirements vs. clinical requirements. Adjust your criteria based on payor feedback and published changes.

Step 4: Setting Up Your Auditing Team (and Using Brellium!)

We usually see the most successful audit teams include providers who've transitioned to the operations side of the business. Your QA team leader should have a comprehensive understanding of both the clinical and business side of your clinic.

Brellium helps all of this move quicker. Instead of needing an army of providers to go through every note one-by-one, Brellium handles the manual auditing so your team can focus on helping providers improve their documentation and standard of care.

Manual audit tips:

• Mark "X" in each cell for each note that's passed audit
• Mark "Contacting Provider" in each cell for each note that failed audit
• Add conditional formatting to highlight cells that contain "Contacting Provider"
• Create a third tab that uses a VLOOKUP/INDEXMATCH to give you the number of error instances per provider

Step 5: How to Have Providers Fix Errors

At the end of each auditor's day, they should go through each of the cells they've marked as "Contacting Provider" and send an individual email to the provider specifying the note's day and time, and what needs to be fixed.

Step 6: Responding to Payer Audits

If you're manually auditing notes, ask your team to focus on only the clients the payer has requested for the audit period for 1–2 weeks. It's essential to make sure the initial audit goes smoothly.

Brellium provides a clawback guarantee, where if we make a mistake that a payer claws back on, we pay the bill. Not you.