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Preparing for your UBH Audit: Tips and Lessons Learned for Autism Treatment Providers

The final step in the contracting process with United Behavioral Health (UBH)/Optum is an audit. Depending on the type of agency, the audit may involve either a site visit by an auditor or a remote audit in which the autism treatment provider must send in documentation demonstrating that their practice and practitioners meet with UBH’s requirements.

The UBH website offers prospective “auditees” access to the actual audit tools the auditors use. UBH has established a performance goal of 85% for all three audit tools used to evaluate autism treatment providers.

Access to the audit tools is a huge step towards understanding what the auditor will be looking for and how he/she will evaluate the agency, practitioners, client/patient files, policies and procedures. But, in reality, just a glimpse at the audit tools causes most agencies to fly into a panic. The tools are a stark wake up call to most autism treatment providers that they are, through no fault of their own, horribly ill-prepared for their audit. The sense of panic is further exacerbated by having no idea how to prepare, what actually needs to get done to get ready or how to go about successfully demonstrating that they meet UBH’s requirements.

My extensive experiences in assisting agencies prepare for their UBH/Optum audits, taking an active role in all of them successfully passing with nearly half of them achieving a perfect 100% score on all three audit tools, has taught me several valuable lessons:

Start preparing for the audit as soon as you submit you initial application

Getting your “ducks in line” for your audit is a herculean effort that will take a great deal of time, effort and manpower. Do not wait until the auditor contacts you to set a date for your audit to start preparing. Kicking the can down the line is a sure-fire recipe for unnecessary stress, and sadly, not the outcome you are hoping for.

The ideal time to start preparing for your audit is as soon as you have submitted your Network Participation Request Form (NRPF). It often takes several months for the contracting department to respond to your request and to move you on to the next credentialing/contracting phase. Take advantage of this window to get to work on preparing the required documents. The ability to work “part time” on this project while continuing to perform your “regularly scheduled” workload is a luxury you will not have if you wait until later in the game to get started.

Do NOT assume that because you are an expert in your field (which you, no doubt, are) that the audit will be a “piece of cake”

Just because you are AMAZING at what you do, does not mean that you are ready to pass the audit without doing some serious preparatory work. Even the most established agencies with the best reputations and the greatest clinical experience in treating individuals with autism will need to put in some serious work to pass the audit.

Autism treatment providers are being asked to show that they understand and can operate within the “medical model”. This new “platform” brings with it a brand new set of standards, operational requirements, policies and procedures, which have never before been applied to autism treatment providers. It’s up to you to show that you can adapt to these new expectations and meet the required standards.

Go into the process with a positive attitude

We’ve already established that preparing for your audit is a huge job that will take up a massive amount of time you really don’t have. But, if you want to get contracted with UBH, you simply have no choice.

My advice is dive in with a positive attitude! Commit to the process with the up-front appreciation that after you’ve successfully passed the audit because you put in the effort, adapted your operational and practical work processes, created the necessary policies and procedures, updated your clinical observation, reporting and supervisory documentation trail and made all the other necessary changes and modifications to how you do what you do and how you document it, you will be better for it! Look at it as an introspective quality improvement opportunity that will benefit your practice, practitioners and your clients when you done.

There is no one-size-fits-all solution to preparing for the audit

There is no single “right” way to meet UBH’s requirements. Each agency has its own set of beliefs, its own way of doing things, and its own clinical and practical approach; and that’s a good thing. UBH is not looking for you to turn yourself into something you are not or to lose any of those special “somethings” that make you so wonderful at what you do. What UBH is looking for is confirmation that you meet their requirements while maintaining what makes your practice and the services you provide unique. Conclusion: use your existing policies, procedures and documents as the basis for the updated “versions” that incorporate the new requirements. This approach will ensure that you aren’t losing “yourself” in the process.

Don’t presume to know what is important to the auditor

In an effort to save time and energy there is a tendency to want to prioritize the requirements. I encourage you to fight the urge! When all is said and done, you should have a complete set of documents that answers each and every one of the requirements described in the audit tools because you simply never know what the auditor is going to hone in on at your specific audit.

Get help

Preparing for the UBH audit is most definitely not rocket science. But knowing what you don’t know is the biggest barrier to success. So, just like when there’s something wrong with your car you seek out the expertise of a mechanic, when you’re preparing for your UBH audit, consulting with an expert will help you get the job done right.

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