How to achieve Long Term Recovery?

26 May

Don’t leave treatment when you “feel better”. It is often as simple as that. Studies prove that longer stays in treatment settings directly correlate to extended sobriety. Having worked in the addiction recovery field for the past 16 years I have seen clients leave treatment the instant their withdrawals subside. They begin to feel good again and instantly feel invincible; like they have it all figured out and can take on the world without fear.

Almost every time I remember a client leaving treatment ASA (against staff advice) I will hear that they have relapsed and either want to come back to us at Cornerstone, have checked in at another facility, are in jail or worse. Many of the negative reviews we have received over the years on our different social media and online accounts say things like, “They are all about the money!” or “My case manager wanted me to stay longer so they could milk me for more money,” or some other form of anger towards our program and staff who were only looking out for the client’s best interests.

We would be very pleased to know that each time a client ‘feels better’ and leaves the program early they continue on the path to long term sobriety but this is truly not the case. We are in this business to help addicts recover. Period. We do not attempt to keep any client any longer than we feel is beneficial to them and their individual recovery program.

Protect Your Organization and Provider Network from Insurance Fraud and Abuse in the Substance Use Disorder (SUD) Treatment Market

15 Feb

 

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Ten years ago managed care organizations were primary and foremost referral agents for those seeking addiction treatment. This was a time when case-management and referrals were managed by real people in real time. Since that time, insured members find SUD treatment providers independently and often through misleading call-centers/ patient brokers on the internet. Head hunters get paid top dollar by out-of-network providers for PPO insured or well-funded candidates.

As some unscrupulous entrepreneurs build profitable businesses through unethical practices, their abundant marketing budgets have overtaken the market. Ethical, in-network, insurance contracted providers do not have comparable marketing capital to compete. They operate off of a highly discounted rate of reimbursement which result in meager marketing/ promotion budgets.

SUD providers are incentivized to drop or avoid insurance contracts. Reimbursement is too low and contractual restrictions are too high.

The entrepreneurs are being rewarded by the same PPO plans they abuse, by being paid a percentage of their indiscriminately escalated “usual and customary” rates. Rather than managing ASAM continuing care where the patient resides, the PPO carrier enable the continuation of long residential stays away from home. Insurance carriers willingly pay out-of-area residential programs to extend residential stays by using the day treatment and intensive outpatient treatment benefit while the patient continues to reside in residential, away from home care. No benefits are left to assist the patient integrate recovery back where the wreckage, triggers and real-life problems reside. “Institutionalization” is reinforced by today’s commercial healthcare market.

Following are increasingly common breaches in lawful or ethical practice allowed by an absence of regulation and oversight and willing reinforcement by third party payers:

1) Out of network providers pay for prospective patient premiums (new PPO policies and COBRA) for the duration of treatment then allow the policies to lapse.
2) Patients are induced to admit by out-of-network providers waiving co-pays and providing sober living to IOP patients.
3) “Usual and customary” services rates are overstated (X10) by out-of-network providers to enhance revenues.
4) Out of network providers escalate their retail “usual and customary rate” for PPO which differs from that offered to their self-pay clientele. Out of network PPO reimbursement is maximized.
5) Payment for referrals are exchanged between out-of-network providers and to “call centers posed as treatment programs” on the internet.
6) Patients are brokered to out-of-network providers from internet call-centers which gage the rate of kick-back based upon the quality and quantity of the caller’s insurance coverage or capacity to pay top-dollar out of pocket.
7) Revenues are enhanced by unnecessarily elaborate, costly and frequent urinalysis testing by out of network providers and laboratories.
8) Intensive outpatient program providers provide “sober living” residence to clientele through the combination of overstated “reasonable and customary” service rates and urinalysis over utilization.
9) UR and billing is contracted out by providers to specialty companies which overstate/ falsify acuity levels and “lethality” to heighten level of care need and length of stay.
10) Internet call-centers and corporate providers mislead viewers and callers about the level of care, type and location of services needed for their condition.
11) Patients are flown from state to state, across the country to engage in out-of-network residential treatment. Once the patient arrives, their choices for level of care and between service providers end.
12) Patients are misled about the amount that the insurance will pay and what will be their likely self-pay amount. “We take your insurance and whatever they don’t cover, we’ll put on a reasonable payment plan”. Residential treatment lengths of stay of thirty to ninety days are rarely medically necessary or covered by insurance.

Following are a few suggestions for third party payer oversight, investigation and enforcement:

1) Require that day treatment and intensive treatment benefits are paid when the patient returns to their residence to enable recovery to be integrated in real time to their real life circumstances.
2) Price up PPO options and replace with affordable EPO plans in benefit offerings.
3) Publicize to service providers and members ethical business standards.
4) Publicize investigations and prosecutions to provide warnings and precedents.
5) Verify acuity levels through second opinions provided by in-network providers.
6) Monitor new policy dates correlated by contemporaneous SUD treatment admission and investigate.
7) Call patients to verify acuity levels.
8) Investigate accuracy of contracted UR and billing.
9) Notify members or require authorized out-of-network providers to notify effected patients of their out of network coverage at the point of admission, including co-pay and deductible amounts and estimated length of authorized reimbursement in real time.
10) Notify or require authorized out-of-network providers to notify effected members and patients the ethical and legal requirements of the out of network provider to collect co-payment and notify them of lapsed level of care authorization.
11) Notify or require authorized providers to notify effected members and patients of in-network treatment providers and alternatives.
12) Deny out of state, out-of-network PPO authorization if in-state providers are available.
13) Deny authorization to providers who lack Joint Commission accreditation.

From Twin Town Treatment Centers – February 3, 2016/in Uncategorized /by idgadvertising

Cornerstone is Licensed, Certified and Accredited!

29 Dec

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Cornerstone would like to thank our friends at the DHCS and JCAHO organizations for their help and guidance in ensuring that we provide the highest quality drug and alcohol treatment services possible to every client in need who comes to us for help.

We have been licensed and certified by the DHCS (formerly the ADP) for 31 years and just went through a rigorous site visit and analysis of 14 of our Residential Recovery Homes as well as our Outpatient Day Treatment Facility. Our analyst was impressed with our program as a whole and told us upon finishing that we did, “Very well”.

We also were visited by three analysts from JCAHO back in November, 2015 and were re-accredited for the next three years!

We are proud of these accomplishments and our caring and professional staff who strive every day to provide the best support and treatment to our clientele.

Unethical Drug Testing

25 Nov

blog-drug-testingOver the past few years we at Cornerstone of Southern California have been approached by many different drug testing laboratories requesting to do our drug testing lab work. We have turned down many different propositions from these companies due to our belief that the agreements proposed to us would be an unethical way to make more money as a company by, in effect, cheating the system.

Unfortunately many of our local competitors were involved in some of these unethical and probably illegal activities.Today we use Quest Diagnostics for all of our urine drug testing needs and we remain loyal to them due to their ethical practices which align with our own.

We have been helping addicts recover from their addictions for 31 years and we still firmly believe that the client comes first.

Take a look at this article to learn more: http://www.justice.gov/opa/pr/millennium-health-agrees-pay-256-million-resolve-allegations-unnecessary-drug-and-genetic

Ethical Drug Testing is a priority at Cornerstone

4 Nov

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Ethical drug testing is a priority at Cornerstone of Southern California and has been since our inception in 1984. Since that time we have seen a trend toward unethical practices by treatment centers and testing laboratories centering around higher profits. So what should ‘Ethical Drug Testing’ look like?

Upon admission to a treatment program it should be required that a full panel, lab tested blood or urine sample is acquired from each individual entering the program. This is usually a requirement by most insurance companies for initial authorizations. The initial test is called a ‘baseline test’ and is extremely important in the first stage of drug treatment in order to know precisely the quality and types of substances which are present in the potential client. This knowledge can then be used by the treatment team and the chosen physician to plan out the initial phase and best possible course of treatment for the individual. If the client is admitted to one of Cornerstone’s Programs they will submit to one monthly laboratory tested and GC-MS (Gas chromatography–mass spectrometry) certified drug test and a weekly urine dip test. Any testing conducted outside of these parameters will be a direct result of observed behavior changes and any suspicion of drug use by the individual.

Cornerstone is an In-Network treatment provider contracted with most insurance companies. This contractual arrangement sets the rates that each insurance provider will pay for treatment services given at our facilities including cost caps for drug tests.  What this means is Cornerstone has not, will not and does not conduct drug tests as a way to drive up profit.  Drug tests are inclusive in our contract rates.