1. Detox Services Revenue Cycle – Code 5200 Bed Days
PatientAccessandRegistrationMedicalandCounselingServicesBilling,Reimbursement&MedicalRecords
Pre-Assessment: Pre-assess and Schedule
Assessor reviews
patient’s current
medical situation
(non-Dx)
Substance Abuse
Detoxification Unit:
Admission Medical
Screening ICD-10
Form (DAMS)
Key Restraints:
· Must perform codes 3604, 3605,
3606, 4011, 5200
· Must have valid Diagnosis
Times
Check-in: n/a
Waiting, Check-in to Assessment: 10-120 min
Pre-assessment: 15 min
Waiting, Pre-assessment to Financial: 12-20 min
Financial: 20 min
Waiting, Financial to Vitals: 3-5 min
Review of Systems: 60 min
Waiting, Review of Systems to Physical: 5 min
Physical: 30 min
Waiting, Physical to Admission: 2 min
Admission: 10 min
Counselor Session: 15-60 min
Dispense Meds: 5 min
Vitals: 5 min
Total Beds Total $
Full Capacity 28 5,040$
Census 6 Mo. Average 27 4,860$
Difference / night -1 (180)$
Total @ 6 mo average -180 (32,580)$
Front Desk: Gather demographic information and consent
Patient Enters
Restoration
Reception Area,
requests Detox
Services
Schedule patient
Detox Admission
Financial Assessment
Determine
appropriate funding
source based on
patient
demographics
Patient verifies
status on
appropriate form
Physical: Prescribe detox services
Provider performs
physical
assessment
Performs physical
Signs off on Dx
Protocol and
medications
MH Plan from non-Physician
(Medications): BILL CODE 3605
Patient Education, non-Physician
(individual, per session): BILL CODE
3606
MH Assessment from non-Physician
(Medications): BILL CODE 3604
Psychosocial Rehabilitation Services:
BILL CODE: 4011
Review of Systems: Vitals and history
Alcohol and/or drug abuse services, not
specified (room and board):
BILL CODE: 5200
Audit and resolve claims Document Scanning
Nurse dispenses
Medications
Update CMBHS
Nurse observes
physical and
behavioral
symptoms
Update CMBHS
Follow and notate in
MAR
Update Nurse Flow
Chart
Nurse takes vitals,
asks about and
observes
withdrawal
symptoms
Update CMBHS
Enter in OOWS/
CIWS
Counselor meets
with patient
Discuss treatment
Plan with patient
Update CMBHS
Completes Review
of Systems
questionnaire
(family history, drug
use, etc)
Urinalysis, BP, BG,
TB test,
Breathalyzer
Generates MAR (bill
3605)
Generates OOWS /
CIWA (bill 3604)
Nurse performs RoS
and vitals
Detox
Reimbursement
Specialist enters
code
Verify patient
satisfied other 4
codes for prior day,
add 5200
Update Anasazi
Central
Reimbursement
Specialist
Audit suspense and
denial reports to
resolution
Update Anasazi
Medical Records
Specialist
Reviews documents
to scan into patient
record
Scans document
into Anasazi
Salaries
Provider: 60.00
RN: 30.00
LVN: 19.75
CNA: 12.50
LCDC: 16.50
Reimbursement Spec: 13.00
Medical Records: 12.50
Front Desk: 12.50, 14.00, 14.00
1. 5200 code being added manually
1. Could these documents be created
and stored in Anasaai?1. Suspense reports take precedence
over denial reports. Can systems help
enter correct information the first
time?
1. Can these be entered
electronically?
Would free up this person
1. We are dedicating MANY
resources before we are able to
provide billable services
1. Is scheduling necessary?
2. Could pre-assessment and
financial assessment be combined?
3. OR, pre-assessment and RoS
combined?
Page 1
Registration and
Financial
Assessment
(HIPAA & AOB)
Demographics,
Insurance &
Financial
Information Sheet
Substance Abuse
Services Consent
General Consent to
Assessment,
Treatment and
Services

2. Detox Services Code 5200 - Bed DaysPatientAccessandRegistration=$94.85(perprocess)
MedicalandCounselingServices=$29.25(per
process)
Billing,Reimbursement&Medical
Records=$2.91(perprocess)
Billable Services:
Per-Process Cost = $29.25
Per-Day Staff Cost = $1440
Non-Billable Services:
Per-Process Cost = $97.76
Per-Day Staff Cost = $2289.92
40% of patients
are re-scheduled
60% of patients are
screened and NOT
admitted
Clinical - Assessment (LCDC INTERN): $4.20 per process Financial Assessment: $6.25 per process
Medical - Physical (RN): $60.00 per process
Automate
CMBHSMH Plan from non-Physician (LVN):
$8.25 per process
Automate
CMBHS
Patient Education, non-Physician
(LVN): $1.65 per process
Automate
CMBHS
MH Assessment from non-Physician
(LVN): $8.40 per process
Psychosocial Rehabilitation Services:
(Counselor): $9.30
Medical - Review of Systems (LVN): $19.80 per process
Automate
Anasazi
update
Alcohol and/or drug abuse services, not
specified: $1.65 per process
Automate
Anasazi
updateClaim Processing: $2.70 per process
Don’t print out
document =
no scanning
Document Scanning: $0.21 per process
Legend
Patient Enters
Restoration
Reception Area,
requests Detox
Services
Check-in
$4.60
Pre-Admission
$4.20
Financial evaluation
$6.25
Review of Systems
$19.80
Physical
$60.00
Dispense Meds
$8.25
Nursing Flow Chart
$1.65
Vitals
$8.40
Counseling Service
$9.30
Finalize Billing Strip
$1.65
Submit Claim,
reconcile Anasazi
$2.70
Assessor reviews
patient’s current
medical situation
(non-Dx)
Substance Abuse
Detoxification Unit:
Admission Medical
Screening ICD-10
Form (DAMS)
Eliminate
document data-
entry tasks Front Desk: $4.60 per process
Patient Enters
Restoration
Reception Area,
requests Detox
Services
Schedule patient
Detox Admission
Determine
appropriate funding
source based on
patient
demographics
Patient verifies
status on
appropriate form
Provider performs
physical
assessment
Performs physical
Signs off on Dx
Protocol and
medications
Nurse dispenses
Medications
Update CMBHS
Nurse observes
physical and
behavioral
symptoms
Update CMBHS
Follow and notate in
MAR
Update Nurse Flow
Chart
Nurse takes vitals,
asks about and
observes
withdrawal
symptoms
Update CMBHS
Enter in OOWS/
CIWS
Counselor meets
with patient
Discuss treatment
Plan with patient
Update CMBHS
Completes Review
of Systems
questionnaire
(family history, drug
use, etc)
Urinalysis, BP, BG,
TB test,
Breathalyzer
Generates MAR (bill
3605)
Generates OOWS /
CIWA (bill 3604)
Nurse performs RoS
and vitals
Detox
Reimbursement
Specialist enters
code
Verify patient
satisfied other 4
codes for prior day,
add 5200
Update Anasazi
Accountant Submit claim Reconcile Anasazi
Medical Records
Specialist
Reviews documents
to scan into patient
record
Scans document
into Anasazi
Gather demographic
and insurance
information,
consent form
Registration and
Financial
Assessment
(HIPAA & AOB)
Demographics,
Insurance &
Financial
Information Sheet
General Consent to
Assessment,
Treatment and
Services
Provider reviews all
information from
nurse, advocates for
Detox recovery
Central scanning
QCs each document
Document Scanning
$.21
$60.00
$19.80
$9.30 $8.40 $8.25 $6.25 $4.60 $10.41
47.2%
62.8%
70.2%
76.8%
83.3% 88.2% 91.8%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
$-
$20.00
$40.00
$60.00
$80.00
$100.00
$120.00
Dollars
Process
ProcessCost
$960.00 $950.40
$446.40 $331.20 $278.40 $259.20 $201.60 $201.60 $101.12
25.7%
51.2%
63.2%
72.1%
79.5%
86.5%
91.9%
97.3%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
$-
$500.00
$1,000.00
$1,500.00
$2,000.00
$2,500.00
$3,000.00
$3,500.00
Dollars
Staff Title
Detox- PerDayStaffCost
Document
Opportunity
Process
1 2 3
4 5
7
6
8 9
Detox - Per Process Cost Detox - Per Day Staff Cost
Required for admission, but not
directly bill-able
Diagram Page 1
Diagram Page 2

3. Systems
Personnel
Paper Anasazi CMBHS Excel
CSR
(front
desk)
LCDC LVN Provider CNA
Reimbur
sement
Spec
Medical
Records
Mental Health Assessment, non-
physician (3604)
Mental Health Plan, non physician
(3605)
Mental Health education, non-
physician (3606)
Psychosocial Rehabilitation (4011)
Other Services, room and board
(5200)
Medical and Counseling Services
Billing, Reimbursement and Medical
Records
Audit Claims
Resolve Claims
Document Scanning
Patient Access and Registration
Check-in
Pre-assessment
Financial
Review of Systems
Provider Assessment
Admission
Page 2

4. Staff IDEA: Considering
scheduling conflicts and no-
shows, why schedule?.
Purpose: Maximize available
beds
Wasted
movement
Patient Enters
Restoration as a
Walk In
Patient Enters
Restoration
Through Sobering
Patient Enters
Restoration as an
Appointment
Checks-in at front
desk
Returns to front
desk with
demographic sheet
filled out
Staff updates
Anasazi and creates
paper file
Front desk staff
notifies Medical
pre-assessor of
potential Detox
client
Pre-assessor walks
to front desk, brings
patient and
paperwork to pre-
assessment office
Assessor reviews
patient’s current
medical situation
(non-Dx)
This sheet is
printed on colored
paper, difficult for
MR to scan
Substance Abuse
Detoxification Unit:
Admission Medical
Screening ICD-10
Form (DAMS)
Assessor consults
with Provider to Dx
Is patient viable
for Detox
services?
No
Financial person
called, walks from
different building
Kanban
Patient moves to
financial approval
office
Does patient
have insurance
we accept OR no
insurance?
No
Can patient
prove Bexar
County
residence?
Yes
TAP/Carelink
Process
Yes
No
Kanban
Patient moves to
nurse for Review of
Systems
Does drug
screen come
back positive?
Refer to IHRP
No
Kanban
Patient moves to
Provider
Yes
Auto-fill
form?
DSHS will fund, pays
~100% of claims
submitted
Registration and
Financial
Assessment
(HIPAA & AOB)
Demographics,
Insurance &
Financial
Information Sheet
Have patient sign
“No insurance, no
proof of ID” form
Does patient
pass physical?
Patient sent to
hospital
No
Patient personal
property
inventoried and
locked up
Yes
Is patient
capable of
speaking with
Counselor?
Counselor will have
brief ‘introductory’
session with patient
Yes
Patient goes to
sleep, watch TV,
courtyard
No
CODE 3605:
Take meds every 4
hours
CODE 4011:
Meet with
Counselor
CODE 3604:
Vitals checked once
daily and CIWS/
OOWS filled out
Patient discharged
Dx may require
LCDC signature
before moving
forward.
Counselor Process
Return patient
property
Key Restraints:
· Must perform codes 3604, 3605,
3606, 4011, 5200
· Must have valid Diagnosis
Look up patient in
CMBHS to review
notes, bring to
office from waiting
room
Discuss treatment
plan, Notate in
CMBHS; BIRP note
Close-out file in
CMBHs, return
patient to day-room
Audit daily census
print-out to make
sure patient is
available
Provider leaves
paper file for IN-
HOUSE
reimbursement
specialist
Is billing strip
correct?
Save billing strip in
Anasazi for billing
Yes
Investigate cause
for discrepancy
No
Reconcile Census
report (excel) with
CMBHS
Send email to LCDC
to update status in
CMBHS
OR
Provider to mark as
discharge AMA
LCDC Update
CMBHS
Auto-fill
form?
Patient to apply for
TAP/Carelink
Is patient
homeless?
Patient cannot
apply for TAP, apply
for DSHS
No
Is patient
resident of
Bexar County?
Yes
Patient cannot
apply for TAP, apply
for DSHS
No
Front desk supplies
copy of
demographics and
credentials (ID & SS)
Yes
Finance person fill
out TAP application
online
Print out
application, patient
signs
Generate Letter of
Good Faith using
template on shared
drive
Print out, walk to
other building for
LCDC to sign
Return to desk, scan
in signed
documents
Forward scanned
documents via
email to UHS
Once UHS responds,
enter Dates of
authorized
service(s) into
Anasazi
Fill-out Carelink
(UHS) form with
applicant
information
Fax information to
Carelink
authorization dept
Log into IDX and
look up patient’s
authorization
Email authorization
document to
Central
Print out hardcopy
for records
· Our total time for TAP processing
approximately 35 minutes (assumes all
resources are received and available)
· UHS drives need for this process
Paperwork filed
with patient Record
Refer out or to IHRP
Refer to contracted
provider
Central
Reimbursement
Process
Patient claim sits for
1 week in suspense
report for retro-
revisions
Does billing strip
have all required
information?
Send back to clinic
reimbursement
contact for
resolution
No
Post ClaimYes Is claim denied?
No action required
No
Reimbursement File
for appeal
Yes
Kanban
Census report is
printed out and
becomes a static
document.
Times
Check-in: n/a
Waiting, Check-in to Assessment: 10-120 min
Pre-assessment: 15 min
Waiting, Pre-assessment to Financial: 12-20 min
Financial: 20 min
Waiting, Financial to Vitals: 3-5 min
Review of Systems: 60 min
Waiting, Review of Systems to Physical: 5 min
Physical: 30 min
Waiting, Physical to Admission: 2 min
Admission: 10 min
Counselor Session: 15-60 min
Dispense Meds: 5 min
Vitals: 5 min
Enter patient
information in
CMBHS
Verify pt does/not
have Medicaid
Medicaid patients
accepted only as
scheduled on
Wednesday and
Thursday – NO
Walk-ins
Nurse asks patient
questions, fills out
Review of Systems
form in Anasazi
RoS form
(electronic): family
history, drug use,
etc.
Nurse generates
Chart
Cardex (general
patient overview
and protocol)
Print/Copy, adds:
Documentation
related to patient
history and test
results to chart:
Nurse performs
tests
Urinalysis, TB test,
Breathalyzer,
Glucose, BP
Personal Property
Inventory
Substance Abuse
Services Consent
General
Acknowledgement
General Consent to
Assessment,
Treatment and
Services
Substance Abuse
Consumer Bill of
Rights
Substance Abuse
Services Consent
General Consent to
Assessment,
Treatment and
Services
These two forms
were signed at
check-in!!!
TAP/Carelink begins
working on Retro-
Medicaid coverage
for patient
Is TAP/Carelink
successful in
acquiring
coverage?
No
TAP/Carelink
requests
reimbursement of
funds from CHCS
Yes
CHCS
Reimbursement
verifies Retro-
Medicaid Coverage
CHCS
Reimbursement
acquires
authorization from
Medicaid
Reimbursement
files Retro-claim
with Medicaid
Is claim
approved?
Funded
Yes
Funded
Adds printed
labels to each
document
Follow Appeals
process
No
Is appeal
successful?
Yes Write-offNo
Update census
report with either
admission or
scheduling
information
Yes
Why print
these at all?
Patient vitals taken,
medicated
Patient vitals are
taken every hour for
the first 4 hours
Medication
dispense process
MAR (Medication
Administration
Record)
OOWS and/or CIWA
depending on
substance detoxing
from
Add to Chart
Vitals process
Bring patient into
nurses station
Gather BP, Temp,
HR & RR data
Return patient to
day-room
This data is entered
into CMBHS
Staff IDEA: Need a better way
for counselors, staff and
patients to communicate.
Purpose: Set expectations
CODE 3606:
Nursing notes filled
out once per shift,
based on
observation
Where do these
go?
Patient fills out exit
survey
File is reviewed by
CENTRAL
Reimbursement
Specialist
Automate
audit?
Is patient ready
for discharge?
Automate
adding code?
CODE 5200:
Update Anasazi
with code for
patients still in
detox
Automate
audit?Reimbursement
Specialist audits
each file in CMBHS
vs Anasazi for
accuracy
Enter observed
symptoms on
OOWS/CIWS score
sheet
Nursing flow chart
filled out
Medical Records
Process
Divide patient
documents into
medical and non-
medical, scan
Medical first
Is patient
Medicaid?
Verify policy is
active in TMHP
Yes
Look up patient
profile in Anasazi
No
Is document
appropriately
stamped with
Medicaid ID?
Stamp front and
back of each
document in the
patient chart with
Medicaid ID
No
Yes
Assign date,
document type,
document title &
source in Anasazi
Scan document
Did document
scan
successfully?
No
Spot-check
document
Save documentYes
Route hard-copy
document to
Central Scanning for
QC
No
Physician’s
Discharge Orders
Yes
Sign off on Personal
Property Inventory
Central Scanning
Process
Courier service
delivers documents
to Central
Review physical
document for
completeness and
accuracy
Review Attachment
in detail in Anasazi
Is document
properly
scanned?
Shred
Yes
No
Does inaccuracy
require licensed
revew?
Fix document, scan
in
No
Route back to
Medical Records to
rectify
Yes
Yes
Reviews Review of
Systems that nurse
performed,
confirms
information notated
in Anasazi
Questions patient
about outcomes
from participating in
program
Review patient
chart, update
Anasazi with
descriptive notes of
Nurse’s Review of
Systems
Performs physical
Provider walks
patient back to
locker-area
Provider updates
hard-copy patient
chart to submit to
Nurses’ Station
Provider approves
patient Protocol in
Anasazi
Patient Chart is
routed to Medical
Records
Total Beds Total $
Full Capacity 28 5,040$
Census 6 Mo. Average 27 4,860$
Difference / night -1 (180)$
Total @ 6 mo average -180 (32,580)$
Impact of missing one bed per day
Central
Reimbursement
Process
If payer is TAP/Carelink
Manually
Entered by
Customer
Specialist
Manually
Entered by
Reimbursement
Specialist
Page 3 Page 4 Page 5 Page 6
Unit nurse cross
checks MAR with
medication supply in
med cart.
The Med Tech, CNA,
Unit Nurse call
patients to the med
window at the
nurses station.
If patients are not in
the common area, a
team member finds
patient.
Patients line up at
the medication
window, one by
one.
MAR cross
checked with
pt detox
protocol,
medication
privided to the
pt.
Medication
administered is
recorded in the
MAR
Nurse documents
symptoms, side-
effects or refusal
Assessor enters
patient info into
CMBHS
Finance has
to walk
over!

5. Reference Census
Update ‘nurses’
census
Update vitals sheet
with any new
information
Take vitals
Enter vitals
information in vitals
spreadsheet
Enter vitals in
patient chart
(OOWS)
Enter data into
CMBHS
Reimbursement
enters into Anasazi
Bill for services from
Anasazi