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Regulatory Compliance

· Ask at least one question in response to an original peer post that you would like the author to explore further.

· Support your initial and subsequent posts by citing at least two academic resources

Please respond to at least two of your classmates by Day 7 with your responses being approximately 75-100 words in length.

AUDREY POST:

Compliance Programs

     If I was the president and CEO of a behavioral health organization two activities that I would choose to focus on for quality and performance improvement are the verification of the qualifications, credentials, and exclusion status of clinicians whose services are reimbursed by federally funded health care programs and ensuring strict adherence to federal and state requirements for informed consent in the provision of BMHS, including psychotropic medication management services (Nguyen, 2010). Making sure that clinicians are qualified and have good credentials will ensure quality care of my patients and in turn we, as an organization, will be able to provide them with the best help for their behavioral health needs. Also, informing a patient of their care, as well as coordinating with the clinician or physician, is important because it is important that a patient understands their care and trusts the clinician or physician and excellent communication can build both understanding and trust(American Psychological Association, 2013).

     I would implement these procedures by having a staff meeting and being clear as to what these two procedures mean and what will happen if we do not adhere to them. I would also be very specific in what they mean exactly with examples of how to follow the procedures and how not to follow them so that everyone understands them. I would make sure that everyone has a copy of the rules to ensure that they have something to look back on just in case they forget. I would be very clear that these procedures need to be followed and that it is important for our organization and patients to follow these procedures. Then I would regularly check in with my staff to make sure that the procedures are being followed and that we as an organization are doing the best we can to provide quality care to our patients.

References

American Psychological Association. (2013). HIPAA: What You Need to Know. The Privacy Rule: A

     Primer for Psychologists. http://www.apapracticecentral.org/business/hipaa/hipaa-privacy-primer.pdf (Links to an external site.)

Nguyen, D. (2010). The health care reform bill: Compliance implications for behavioral and mental

     health services. Journal of Health Care Compliance, 12(4), 11-14, 61.

     http://proquest.umi.com/pqdweb?did=2085893211&sid=1&Fmt=3&clientId=101586&RQT=309&VName=PQD

CARMEN’S POST:

Regulatory Compliance

I really enjoyed this week's reading as it teaches us about best practice and keeping in compliance with the state requirements. Nguyen focused on ways to stay in compliance by having quality of services and assessing programs for performance improvement. Two of the integration activities that Nguyen spoke that as a CEO I would address are: 

· Verification of the qualifications, credentials, and exclusion status of clinicians whose services are reimbursed by federally funded health care programs, and,  

· Improving clinical documentation practices. 

These are very important factors in the organization in which I work called CTSHealth. The first activity is essential as the qualifications of the staff must be verified for several reasons. 1) For billing services each credential is paid differently. It is important to understand each credential that is appropriate for your services. For an CMHC in illinois we can hire the following: 

Rehabilitative Services Associate (RSA) - Must be 21 years or older, High School diploma or GED, With less than 3 years of experience. Mental Health Professional (MHP) is an individual 21 years or older with a Bachelors in Science minimum, 5+ years in mental health. A Qualified Mental Health Professional (QMHP) is an individual who has a Masters in Science. Lastly a LPCP, LCSW, or LPHA are individuals that are licenced. Having the appropriate competent staff is essential to make sure that not only the agency is compliant with state requirements but also that the clientele obtains the appropriate services. As a CEO I would want to make sure that my staff is knowledgeable and aware of services and regulations to complete their role duties. Below are some links that are useful such as Rule 132 which is important for all staff in mental health to have some knowledge about the rule. Also, having the credential staff helps for billing purposes as the higher the level of education the higher the fee for services. Attached are the billing codes to get an idea of how the agency gets paid per service per staff credential.  https://www2.illinois.gov/hfs/SiteCollectionDocuments/CommunityBasedBehavioralHealthFeeScheduleEffective10012021.pdf (Links to an external site.)

The second activity I would address as a CEO is making sure everyone is trained on writing clinical notes. Clinical notes are important as they tell the story of the interventions done by staff and outcome of services and consumer progress. At our current location we are retraining staff on clinical notes both Soap notes and Pie notes. Case workers are getting trained on writing notes based on medical necessity. Which means that the reason for services and interventions need to be justified to continue getting authorization. When notes are not enough to justify or have evidence that the intervention is effective the agency gets denials which causes the client not to receive services needed. As a CEO I would like to make sure that my staff is creditable, knowledgeable and properly trained to provide a great quality of service. 

References: 

Nguyen, D. (2010). The health care reform bill: Compliance implications for behavioral and mental health services. Journal of Health Care Compliance, 12(4), 11-14, 61.

Website for Insight :

For Billing Guidance : Community Mental Health (CMHC) 

https://corp.mhplan.com/ContentDocuments/default.aspx?x=ssDl3y/8aFA8NOU97GJMPbMnS4D7SmIF+tc+jvEZJfibFLzq7B78WsZgrX95Skg5XeaWERhmmzmw68h19u4K1w (Links to an external site.)

Rule 132-Guidelines for CMHC 

https://www.dhs.state.il.us/OneNetLibrary/27896/documents/By_Division/MentalHealth/Rule132/2020/06192019-IDHS-Rule132-PresentationNotes.pdf (Links to an external site.)

Process to Certify as a CMHC

https://www.dhs.state.il.us/OneNetLibrary/27896/documents/By_Division/MentalHealth/2020/Rule132/01292020-PDF-CMHC-CSP-ENROLLMENT-PROCESS-FOR-PROVIDERS-WITH-PRESENTATION-NOTES.pdf (Links to an external site.)

Insurance Claims for Authorizations (Meridian)

https://corp.mhplan.com/ContentDocuments/default.aspx?x=ssDl3y/8aFA8NOU97GJMPbMnS4D7SmIF+tc+jvEZJfibFLzq7B78WsZgrX95Skg5XeaWERhmmzmw68h19u4K1w (Links to an external site.)

 Suppliers

Guided Response: Respond to at least two of your classmates’ posts in a substantive manner. Some ways could include examples, current events, and/or possible outcomes. Must use references.

Vincent’s Post;

Hello Class,

As a firm decides whether or not it should have fewer or more suppliers, it needs to take into consideration what kind of business it is running and how the organization operates as a whole. Companies that offer a breadth of products such as large retailers (Amazon, WalMart, Target, etc.) will most likely have a large number of suppliers. This is because these types of organizations offer such a wide variety of products that a single or just a few suppliers would not only be able to meet the demands of their product mix, but also insufficiently keep up with the high output of products that these companies sell. On the other hand, smaller or more niche focused organizations that sell or produce specialized products may only have one or a select few number of suppliers. This could be due to a certain supplier being the only supplier available that supplies a specific product or part that is vital to the niche product being manufactured. Also, smaller organizations that produce or sell a narrower variety of products don’t necessarily need multiple suppliers and doing so could actually complicate operations.

Some advantages with having multiple suppliers would be that your options for solutions can be broader. If something were to go wrong with one supplier and another supplier you were working with could provide a solution or substitution, this would save the hassle of having to look around and find a whole new supplier. Multiple suppliers also tend to drive competition within the suppliers and can lead to lower costs for the organization. Alternatively, having a large number of suppliers for your organization can lead to many complications within the supply chain and would require a larger workforce to ensure this process of the business is running smoothly.

Advantages with only having a few or just one supplier could include building strong relationships with these suppliers over time from a business standpoint. These types of relationships can lead to frictionless business operations as overtime supplier and organization can come to understand how each other works. These relationships can also have small perks such as loyalty discounts if suppliers offer such things. On the other hand, relying on a select few or just one supplier can be sort of a “all your eggs in one basket” type of situation. When relying on a single supplier, risk of failure could be detrimental if a supplier fails you because you wouldn’t have another supplier in your books that could substitute for the time being.

 

Vonderembse, M. A., & White, G. P. (2013).  Operations management  [Electronic version]. Retrieved from https://content.ashford.edu/

Federico’s Post:

Suppliers

When deciding a supply chain strategy with dedicated or multiple suppliers, an organization must weigh several factors. The decision must consider the pros and cons of each approach. Suppose the company elected to work with various suppliers. In that case, it will reduce the risk of running out of material inventory, but at the same time, will add complexity to its supply chain by increasing the participants to share the company’s purchasing information. According to Vonderembse & White (2013), by using a variety of suppliers, the company will take advantage of the competition between them, which will help in reducing the cost of their supplies (chap. 5.4).

On the other hand, having few or even a single supplier strategy will require the company to develop reliability and responsiveness on such a supplier. The company will benefit by easily integrating their information databases systems, like Electronic Data Interchange (EDI) or Material Requirements Planning (MRP). But also having single-sourcing could create dependency, increasing vulnerability and risk of supply interruption. However, Nelson (2013) states that “Splitting demands would only make the supplier less responsive and would make it more difficult for them to dedicate resources to resolving quality and capacity issues” (p. 4).

In summary, the proper supply chain management decision will also depend on the business sector or even the organization’s size. A smaller company could have less flexibility in choosing suppliers. Large focal firms usually have strong negotiation power, reaching beneficial agreements with several suppliers, which will considerably reduce their purchasing prices. This situation is a reality in the steel company where I work. The centralized purchasing system, based on SAP, will allow the employees to buy products from many retailers, like Grainger or Motion Ind, with discounted prices up to 15% below regular internet prices.

References

Vonderembse, M. A., & White, G. P. (2013). Operations management. Bridgepoint Education.

Nelson, J. (2013, February 28). Evaluating Supply Chain Risks with Single vs. Multiple Vendor Sourcing Strategies.  https://spendmatters.com/2013/02/28/evaluating-supply-chain-risks-with-single-vs-multiple-vendor-sourcing-strategies/

 Forecasting Methods

 Forecasting Methods

Guided Response: Respond to at least two of your classmates’ posts to identify some of their recommended forecasting methods. Give additional advice and alternative solutions that might be used as well. Use 2 additional references.

VINCENT’S POST:

A.) Calculate a 5-year moving average to forecast the number of mergers for 2012.

 

Calculated 5-year moving average from 2007 to 2011

123+97+186+225+240 = 871 / 5 = 174.5 for year 2012

 

B.) Use the moving average technique to determine the forecast for 2005 to 2011. Calculate measurement error using MSE and MAD.

Year

Merger

Forecasted Mergers

Deviation

Square Error

2005

61

52.6

61-52.6=8.4

70.56

2006

83

55.6

83-55.6=27.4

750.76

2007

123

63

123-63=60

3600

2008

97

75.2

97-75.2=21.8

475.24

2009

186

85.6

186-85.6=100.4

10,080.16

2010

225

110

225-110=115

13,225

2011

240

142.8

240-142.8=97.2

9,447.84

In order to calculate the MAD, one would take the total of the deviation sum amount and divide it by the number of years. Calculating the MSE, one would calculate the sum of the squared errors.

MAD: 8.4+27.4+60+21.8+100.4+115+97.2=430.2 / 7 = 61.46

MSE: 37,649.56

C.) Calculate a 5-year weighted moving average to forecast the number of mergers for 2012. Use weights of 0.10, 0.15, 0.20, 0.25, and 0.30, with the most recent year weighted being the largest.

The five-year weighted moving average for forecasting the year 2012 would be as follows:

(.30)240+(.25)225+(.20)186+(.15)97+(.10)123= 192.3

 

D.) Use regression analysis to forecast the number of mergers in 2012.

 

Year

Value for Year (X)

Mergers (Y)

XY

X2

Y2

2000

1

46

46

1

2,116

2001

2

46

92

4

2,116

2002

3

62

186

9

3,844

2003

4

45

180

16

2,025

2004

5

64

320

25

4,096

2005

6

61

366

36

3,721

2006

7

83

581

49

6,889

2007

8

123

984

64

15,129

2008

9

97

873

81

9,409

2009

10

186

1,860

100

34,596

2010

11

225

2,475

121

50,625

2011

12

240

2,880

144

57,600

Totals

78

1278

10,843

650

192,166

b=12(10,843) - (787 x 1278)

b=17.73

a=1278 - 17.73(78)

a= -8.745

r=12(10843) - 78(1278)

r=0.85

Y= -8.745 + 17.73(13)

Y= 221.745

 

Moving averages are often used as an indicator of trends (or lags) within an industry. The moving average was use in this scenario due to its ability to identify the trends of mergers per year over the previous years. Another forecasting method that could have been just as useful would be the exponential smoothing method, which is another form of weighted moving average. It is a procedure for continually revising an estimate to include more recent data (Vonderembse & White, 2013).

 

Vonderembse, M. A., & White, G. P. (2013).  Operations management  [Electronic version]. Retrieved from https://content.ashford.edu/

MELISSA’S POST:

The figures below indicate the number of mergers that took place over a 12 year period in the savings and loan industry: Year Mergers Year Mergers 2000 46 2006 83 2001 46 2007 123 2002 62 2008 97 2003 45 2009 186 2004 64 2010 225 2005 61 2011 240 Calculate a 5-year moving average to forecast the number of mergers for 2012: F2012 = (123+97+186+225+240)/5 = 174.2 Use the moving average technique to determine the forecast for 2005 to 2011. Calculate measurement error using MSE and MAD: F2005 = (64+ 45 +62 +46 +46) / 5 = 52.6 F2006 = (61 + 64+ 45 + 62 + 46) / 5 = 55.6 F2007 = (83 + 61 + 64 + 45 + 62) / 5 = 63 F2008 = (123 + 83 + 61 + 64 + 45) / 5 = 75.2 F2009 = (97 + 123 + 83 + 61 + 64) / 5 = 85.6 F2010 = (186 + 97 + 123 + 83 + 61) / 5 = 110 F2011 = (225 + 186 + 97 + 123 + 83) / 5 = 142.8 YEAR ACTUAL MERGERS FORCASTED MERGERS ERROR SQUARED ERROR 2005 61 52.6 8.4 70.56 2006 83 55.6 27.4 750.76 2007 123 63 60 3,600 2008 97 75.2 21.8 475.24 2009 186 85.6 100.4 10,080.16 2010 225 110 115 13,225 2011 240 142.8 97.2 9,447.84 TOTAL 430.2 37,649.56 MSE = 37,649.56/7 = 5,378.51 MAD = 430.2/7 = 61.46 Calculate a 5year weighted moving average to forecast the number of mergers for 2012. Use weights of 0.10, 0.15, 0.20, 0.25, and 0.30,with the most recent year weighted being the largest. F2012 = (.30)240+(.25)225+(.20)186+(.15)97+(.10)123  = 72+56.25+37.2+14.55+12.3 = 192.3 Use regression analysis to forecast the number of mergers in 2012. Year Coded Value for Year (X) Mergers (Y) XY X 2 Y 2 2000 1 46 46 1 2,116 2001 2 46 92 4 8,464 2002 3 62 186 9 3,844 2003 4 45 180 16 2,025 2004 5 64 320 25 4,096 2005 6 61 366 36 3,721 2006 7 83 581 49 6,889 2007 8 123 984 64 15,129 2008 9 97 873 81 9,409 2009 10 186 1,860 100 34,596 2010 11 225 2,475 121 50,625 2011 12 240 2,880 144 57,600 SUM 78 1,278 10,843 650 198,514 B = 12(10,843) – 78(1,278) / 12(650) - 78^2  = 130,116 – 99,684 / 7,800 – 6,084  = 30,432 / 1,716 = 17.73 A = 1,278 / 12 – 17.73 (78) / 12  = 106.5 – 115.25  = - 8.75  R = 12 (10,843) – 78(1,278) / √[12(650) - 78^2] [12 (198,514] – 1,278^2  = 130,116 – 99,684 / √[7,800 – 6,084] [2,382,168 – 1,633,248]  = 130,116 – 99,684 / √(1,716) (748,920)  = 30,432 / √1,285,146,720  = 30,432 / 35,848.94  = 0.85 The regression analysis is part of the time series methods or qualitative methods to develop a forecast. The charts above indicate a time series method since we're associating information from a single source over a period of time: 2000-2011. The moving average method is the best method. Vonderembse (2013) said that "the purpose of the simple moving average is to smooth out the peaks and valleys in the data" (Ch 6.2). The exponential smoothing method is another method used by averaging past value to calculate a potential future forecast. This method provides reliability because the data used is more recent. References: Vonderembse, M. A., & White, G. P. (2013). Operations management Retrieved from https://content.ashford.edu/