Author
Samuel Jean, co-founder of Unisona Health.
Co-founder of Unisona Health, with more than twenty years building and managing software systems, and the author of every article on this site.
26 articles. Audits, billing, compliance and running a program.
Profile
Who writes this.
Samuel Jean
Co-founder
Technology · 20+ years building and managing software
Samuel has spent more than twenty years in technology, building and managing software systems. He is responsible for the architecture decision that everything else depends on: one tenant, one patient record, one audit log, rather than four products with an integration layer between them.
He is also the reason the API and the data export are not upsells. If you cannot get your records out, you do not own them.
Shaped: the platform, the record model, and the API
Writing
Articles by Samuel Jean.
Compliance
Seven compliance elements, sized for a real program
The seven elements in HHS-OIG compliance guidance, translated for addiction treatment and mental health programs of 20 to 200 staff, with the records that show each one is working.
Clinical documentation
Discharge summaries that hold up in a review
What a discharge summary has to connect to survive a review, the gaps that show up most often, and a closing check you can add to your discharge workflow this week.
Revenue cycle
Revenue cycle KPIs: what to count and how to count it
Clean claim rate, denial rate by reason, days in A/R, unbilled services and underpayment rate: definitions, counting rules and what each one points to upstream.
Clinical documentation
Edited after the claim paid: what a reviewer sees
What a correction to a signed note can legitimately fix, what it cannot, and how the date of the edit changes what a reviewer concludes.
Revenue cycle
Utilization review, from first auth to appeal
Initial authorization, concurrent review, step-down, peer-to-peer and appeal: what each reviewer is looking for, and the records that answer them.
Revenue cycle
What to have ready before a concurrent review call
Continued-stay denials often start on the review call, when the coordinator cannot point to dated, specific clinical facts. Here is what to have ready before the reviewer picks up.
Compliance
Provider credentialing by date of service
A current license status is not enough. How to track credentials, effective dates, payer enrollment, supervision, and history so provider eligibility can be reconstructed for any date of service.
Audit & compliance
Assembling a defensible audit packet
When a records request arrives, finding documents is the easy part. How to reconstruct, reconcile, review, and track one patient’s complete episode of care before the deadline.
Clinical documentation
Turning outcome scores into clinical action
Collecting an assessment is not the same as using the result. How to turn outcome scores into clinical review, treatment-plan decisions, and program insight without overstating what the data proves.
Clinical documentation
A signed note is not a ready claim
A signed note does not make a claim ready. How schedule, attendance, authorization, documentation, provider, and payer data should reconcile before submission, and who owns each gap.
Clinical documentation
Group notes: shared session, individual documentation
Twelve patients can share a group without sharing a note. How to document the session once, keep each patient’s response individual, and let the roster drive the workflow.
Clinical documentation
Current treatment plans, disconnected care
A treatment plan can be current on paper and disconnected from care. How to connect goals, progress notes, reviews, and level-of-care changes so the chart tells one story.
Revenue cycle
From patient estimate to final balance
Why a behavioral health patient estimate and the final balance can differ, what should never become patient responsibility by default, and how to make the difference explainable.
Revenue cycle
What verification of benefits actually tells you
A VOB is a snapshot, not a promise. What verification of benefits can tell a behavioral health organization, what it cannot, and why it should follow the patient past admission.
Revenue cycle
Reading the 835: what the payer actually did
One ERA can hold full payments, partial payments, denials, patient responsibility, and contract variances at once. How to read the 835 for more than the deposit.
Revenue cycle
Seven claim problems to catch before submission
Authorization, provider data, coding, level of care, documentation, demographics, and payer setup: seven behavioral health claim problems worth catching before the payer does.
Revenue cycle
Prior authorization as a workflow, not a field
An authorization can run out of visits or out of calendar, and the department that finds out first should not be billing. How to track approvals, utilization, expiration, and continued care as work.
Revenue cycle
What makes an IOP day billable
Attendance, authorization, documentation, provider, and claim data all have to agree before an IOP patient-day is ready to bill. One day of care, followed through every check.
Revenue cycle
The behavioral health billing guide
How behavioral health billing works end to end — eligibility, authorization, documentation, coding, claims, remittance, denials, contracts, and patient balances.
Audit & compliance
The payer audit playbook
The anatomy of a post-payment review, the deadline you are actually working to, what a complete response contains, and the four reasons programs lose these arguments on paperwork rather than on care.
Documentation
Cloned notes and medical necessity
Why copy-forward documentation is one of the most cited findings in behavioral health reviews, and what separates a defensible template from a cloned note.
Compliance
42 CFR Part 2, explained for operators
What Part 2 requires beyond HIPAA, what a qualifying consent has to contain, and where programs most often over-disclose without realising it.
Revenue cycle
Using outcomes in a rate negotiation
Everyone collects assessments. Almost nobody turns them into something a payer will read. How to package outcome data for a contract conversation.
Revenue cycle
Per-diem and case-rate billing for residential
Bed-days, UB-04s, authorized length of stay, and the reconciliation problems that appear when the census and the claim come from different systems.
Revenue cycle
The five denial reasons behind most behavioral health write-offs
Authorization, medical necessity, enrollment, coding, and eligibility — what each one is really telling you about a workflow further upstream.
Operations
What a records request costs a 40-bed program
Counting the actual staff hours in a manual audit response, from the first download to the last page number written by hand.
Keep reading
Related.
Get started
Start today, or take a look first.
Create your workspace in minutes and try the whole platform free for 14 days — no credit card. Or book a one-hour walkthrough first.