Medi-Cal Documentation Training

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Medi-Cal Documentation Training Powered By Docstoc
					 Santa Barbara County Alcohol, Drug
     and Mental Health Services

      Medi-Cal
Documentation Training
      June 2009 Update

                                      1
          WHY ???
         Laws & Regulations
        Ethical Responsibility
        Best Clinical Practice
                Money

 Accurate documentation is the legal
and ethical obligation of everyone who
   provides mental health services.
                                     2
THE FIRST LAW



            3
         COMPLIANCE
   IS   EVERYBODY’S JOB

All staff are responsible for helping assure
     that services and documentation
 comply with legal and ethical standards.

                       - ADMHS Code of Conduct


                                               4
If you are aware of any possible compliance violations,
you must report them immediately.
You may report to your Supervisor, Quality Assurance, or
the Compliance Helpline.

          phone: 681-5113       fax 681-5117

     e-mail: jsleigh@co.santa-barbara.ca.us

            Helpline (messages): 884-6855




                                                          5
   Reports are confidential.
   People who report are protected by State
    and Federal laws:

                 Whistleblower Protections
               in the Federal False Claim Act:
        31 USC Section 3730 (h) protects employees against
      discharge, demotion, suspension, threats, harassment, or
    discrimination by the employer because of lawful acts done by
        the employee in cooperating with the False Claims Act,
        including investigation for, initiation of, testimony for, or
     assistance in an action filed or to be filed under this section.

                                                                    6
Medi-Cal
Standards




            7
     The Basic Medi-Cal Rule

    Medi-Cal only pays for
  mental health interventions.
Every progress note must say what you did
    and must be related to mental health.

Document all services – but without a mental
    health intervention, code it “No-Bill”
                                           8
          Medi-Cal vs.
       “Whatever It Takes”
   MHSA was set up to pay for services
    not covered by Medi-Cal

So…

   Not everything built into our MHSA
    programs can be billed to Medi-Cal.
                                      9
     Examples: FSP & LOCRI
    MHSA set up special forms that are
     required for some MHSA programs –
     ADMHS requires the LOCRI for adults in
     our clinics.
    Unless something is added to those forms
     to make a billable service,
    Filling out FSP & LOCRI = No-Bill service.

                                              10
         Excluded Diagnoses
      (can’t be listed as “Primary”)
Disorders due to a General Medical Condition
Substance-Related Disorders
Antisocial Personality Disorder
Cognitive Disorders (Delerium, Dementia, Amnesia)
Developmental Disorders
Autistic Disorder
Tic Disorders
Learning Disorders
Communication Disorders
                                                    11
              How Much Time?
    The time you claim must be the actual
     minutes spent delivering the service
    Travel and documentation time associated
     with a service can also be claimed
     If you travel for more than 10 minutes, be sure
      to mention that in your note – don’t make the
      auditors guess!


                                                    12
      Travel vs. Transportation

   Travel means going somewhere so
    you can provide a billable service.
    Whether or not a client goes with you
    doesn’t matter. Travel is billable.

   Transportation means taking a client
    somewhere so somebody else can
    provide a service. Transportation is
    not billable.
                                        13
    Therapeutic Behavioral Services
    This is a special service, only for consumers
     under 21, with full-scope Medi-Cal, who:
     Have serious emotional problems and
      serious behavior problems caused by a
      mental disorder
     Need special 1-to-1 short-term support.

    If you think a child or young adult needs TBS,
     contact the consumer’s Care Coordinator or the
     Manager or Team Supervisor of the nearest
     ADMHS Children’s Clinic.
                                                     14
CLIENT PLANS




               15
  Medi-Cal Rule #2

Medi-Cal only pays for
 interventions that are
    part of a written,
   authorized, signed
      Client Plan.
                          16
          The Client Plan / CSP

Legally required for all mental health providers.
Legally required to bill Medi-Cal or Medicare.
Provides informed consent for treatment.
Lets everyone know the goals of treatment and
   what services that will be provided.



                                                    17
        Medi-Cal Requirements

No services except Crisis Intervention and
   Assessment can be billed without a diagnosis
   and treatment plan.*
A complete, formal Client Plan must be
   developed and signed within 60 days after
   services start.*
The formal plan must be updated every year.
   _____________________________________
      * next page: what to do for 60 days!
                                               18
   But a formal plan takes time!

A Progress Note can authorize services for the
   first 60 days if it includes:
  5-Axis Diagnosis
  Statement of Medical Necessity
  Brief Description of Services

Clinician’s Gateway now has a template that
    meets all these requirements:
                 First Intake
                                              19
Requirements: Formal Client Plan

The client or caregiver must participate in
   developing the plan.
The plan must be approved by
  •   an LPHA or Psychiatrist* -and-
  •   the client or legal guardian
  •   Signatures on paper plans must include a
      DATE to be legal!

                   * Medicare requires a psychiatrist
                                                    20
         Adult Client Signature
   There is NO plan until it’s approved by the
    Client or Guardian.
   Adult clients must either sign a paper copy of
    the plan or decline to sign.
   “Declines” means that the client was offered a
    chance to sign, in a face-to-face meeting, and
    decided not to sign.
   “Declines to sign” is as good as a signature
    and is valid for 12 months.
                                                   21
       Children’s Parent/Guardian
               Signature

   The parent or legal guardian can verbally
    participate in developing a plan and can
    verbally approve it.

   The parent/guardian must sign (or refuse) the
    next time they are seen face-to-face.

   Put the date of the verbal approval in the
    box for the parent/guardign signature.
                                                22
         Contents of the Plan

Goals – specific & observable & measurable
Proposed interventions to address the goals
Duration and frequency for interventions

        Goals and interventions must be
        consistent with the diagnosis



                                              23
                    Goals

A goal is something that the client will achieve
   or acquire by participating in treatment.
There must be at least one goal for every
   impairment and every included diagnosis.
A goal must be something that can be observed
   and measured.



                                              24
 Measurable / Observable Goals

 Client will decrease angry outbursts to a maximum of
   2 per week as reported by family.

 Client will report no more than 1 panic attack per
   week.

 Client will increase compliance with authority by
   attending school 5 days/week.

 Client will increase functioning by complying with
   prescribed medications every day as reported by
   residential staff.
                                                       25
         Common Problem #1
Client will take medications as prescribed.

   Problem: No connection to mental health –
    not the way it’s written.

   Solution 1: Client will manage psychiatric
    symptoms by taking meds as prescribed.

   Solution 2: Client will prevent increase in
    impairments by taking meds as prescribed.

                                                  26
         Common Problem #2
Client will not use alcohol or other
   drugs.
Problem: No connection to mental health
Solution 1: Client will decrease hallucinations by
   abstaining from alcohol or other drugs per self
   report.

Solution 2: Client will improve participation in
   rehabilitation by reducing alcohol use to no
   more than 3 beers per day per self report.
                                                   27
         Common Problem #3

   Client will maintain residence in the
    community.
Problem: No connection to mental health

Solution 1: Client will maintain residence in the
   community as part of recovery.

Solution 2: Client will maintain residence in the
   community by continuing to manage
   symptoms.
                                                    28
                Interventions

   An intervention is an action, activity, or
    service performed by another individual
    (usually a mental health provider).

   A mental health intervention is an
    intervention related to a mental disorder.




                                                 29
              Examples:
      Mental Health Interventions

provide therapy                     teach skills
                  evaluate symptoms
  monitor progress          help access services
educate family       prescribe medications
           gather information
review treatment plan
                        refer to physician
                                               30
A Client Plan must have at least one mental
   health intervention for every goal.

Every intervention must have a frequency and
   duration – how often and for how long.

Basic examples:
     Psychotherapy, 60 min per week, for 4 months
     Med Support, 30 min per month, for 1 year
     Individual Rehab, 30 min per day, for 6 weeks



                                                      31
          New Audit Standard!


   Every program that provides services
    must be listed in the Client Plan.
   Every progress note billed to Medi-Cal
    must be related to the Client Plan.*
* Except emergencies, crises, decompensation



                                             32
       Progress Note Content
Must include:
   The mental health intervention
   A clear link to the client’s mental health
    condition or impairments
Should include:
  Reason for the service
  How the client looks and acts, and what the
    client says
  Results of the service, or a plan
                                                 33
             Progress Notes: “Do’s”

       Write progress notes that stand on their own.
            “Talked to Bob about client’s progress.”
        You and your colleagues may know who “Bob” is –
         but other people don’t!

       Write a progress note for every service activity,
        whether or not it is billable.
       Write a progress note every time a client misses or
        cancels an appointment, and every time you miss
        or cancel.

                                                            34
     Progress Notes: Dont’s”
(1) Don’t just copy and paste notes.
   You can follow a basic outline and use
    basic language – but identical notes will not
    pass an audit
(2) Notes must justify the amount of time claimed
   “Sent fax to pharmacy” doesn’t justify 45
    minutes. Write down what else you did!
(3) Don’t make personal comments or judgments in
    progress notes – words like ugly, stupid,
    repulsive, sexy, and gorgeous aren’t professional

                                                    35
    Warning: Other Client’s Names

   NEVER name other clients in any note –
    violates HIPAA.

   NEVER name any person if you say
    something about that person’s health –
    mental or physical - whether they are a client
    or not.




                                               36
Group Notes: Negative Example
Generic note: “New member Abel Ayala joined
  group today. Reviewed group rules. Demetrius
  Drake talked about his girlfriend being
  pregnant and group discussed pregnancy and
  parenting.”
   When Bob’s medical records are released,
    confidential information about the other group
    members is also released – without their
    authorization.

    Don’t name other clients in any note!
                                                 37
    Individual Notes: Negative Example

    George’s mother Bernadette is taking
     medications to help with her anxiety. His
     brother Arnold is in treatment at Good Sam
     and is testing clean. His sister Edith, who he
     molested last year, is in treatment for PTSD.

    That note includes Protected Health
     Information regarding 3 other people and
     gives information that identifies them.
     That is a serious violation of HIPAA.

                                                  38
Specific Procedures




                      39
        These Services Can Be
        Reimbursed by Medi-Cal
Mental Health Services
  Assessment
  Evaluation and Plan Development
  Therapy – Individual, Family, Group
  Rehabilitation – Individual, Group
  Collateral – Individual, Family, Group
Targeted Case Management
Crisis Intervention
Medication Support Services
Therapeutic Behavioral Services (TBS)
                                            40
 Procedures which can be provided
  by anyone, regardless of license:

Evaluation and Plan Development
Collateral – Individual or Group
Rehab – Individual, Family, or Group
Targeted Case Management
Crisis Intervention
TBS – licensed or under licensed supervision

                                               41
     Eval & Plan Development
EVAL: Gathering information about symptoms
  and functioning – only if it’s clearly related to
  PLAN DEVELOPMENT:

PLAN: Development or approval of plans, and
  monitoring client progress toward plan goals.
   The formal, official Client Plan does not have
    to change – there can be changes in short-
    term interventions and activities.

                                                 42
      A Major Medi-Cal “No-No”

   “Narrative, descriptive notes” cannot be
    claimed – they must be coded “No Bill”.

   To use a service code that bills Medi-Cal, a
    note must describe a mental health
    intervention – something you did.

   Some of us were taught to write exactly this
    kind of note – but Medi-Cal says “NO BILL”

                                                   43
    Narrative, Descriptive Notes
Example: Client neatly groomed, dressed in worn
   but clean suit. Movements, gait, posture stiff.
   Tangential speech at times. Denies
   hallucinations, delusions, SI, HI. Affect
   restricted, described mood as “worried” but
   unable to give details. Getting along with
   parents but he and brother still not speaking.
   RTC 1 week.

       No intervention, code as “No Bill”

                                               44
             “Team” Meetings
   The only people who can bill are people who
    are actively involved in providing treatment
    to the client.

   The total amount of time billed can’t be more
    than 2 times the time the meeting lasted, plus
    documentation.

   Each person who bills must document that
    they made an active intervention involving
    clinical decision-making or clinical thought.
                                               45
Example: Multi-Staff Eval/Plan

    Reviewed client plan with team. Client will
     continue med management, substance abuse
     treatment, case coordination and individual
     therapy with focus on trauma.
     Staff 1: I stated that individual therapy is
      necessary for continued progress.
     Staff 2: This writer asked questions about
      the client’s substance abuse and how it
      relates to her PTSD.
                                                     46
           Multi-Staff Eval/Plan

    Some words that show an active intervention:
     Said
     Suggested
     Asked
     Discussed
     Questioned
     Proposed
     Talked about

                                                    47
         “Clinical Supervision”

   If it looks like clinical supevision, it is
    clinical supervision – and that is a “No-Bill”
    service.

   Consulting, talking with, reviewing cases
    with a person who is not providing direct
    treatment services to that individual
    client is clinical supervision.

                                                48
    Clinical Supervision - example
   Reviewed case with Program Manager. Client
    is not responding well to therapeutic
    recreational activities. Will focus on art
    activities instead.
   If the Program Manager is providing
    Assessment, Rehab, Therapy, or Collateral
    services to that client, this is Eval & Plan.
   If the Program Manager isn’t providing direct
    treatment, this is TCM – No Bill.

                                                    49
                Collateral
Services provided:

   to (or with) a significant support
    person in the client’s life.

   to help the client improve or maintain
    mental health status & achieve goals




                                             50
          Collateral - continued
    Includes:
     consulting, educating, or training the
      person about the client’s treatment, illness,
      progress, ways to help
     gathering information about the client’s
      symptoms, treatment progress, or goals,
      which can be used in assessment and/or
      treatment planning

    Documentation must say how the people are
     related to the client – father, friend, landlord, etc.

                                                          51
       Odds & Ends - Collateral
   Helping the support person with their own
    mental health issues is not billable.
Example: Client’s mother very anxious. Taught
   deep breathing skills. She felt more calm.
   Code as “No Bill” – focus NOT on client.

But: Client’s mother very anxious. Discussed
   client behaviors which have increased her
   anxiety, suggested more effective ways to deal
   with his symptoms. She felt more calm.”
   Code as “Collateral” – focus is on client.
                                                52
     More Collateral Odds & Ends
    Collateral cannot be with another mental
     health provider.
     “Mental health provider” is someone:
       – who has a mental health license, or
       – is paid by mental health Medi-Cal.
     ADMHS or CBO staff, psychiatrists, staff
      at a psych hospital, etc. are “mental health
      providers.”
                                               53
         Working With
“Another Mental Health Provider”

   Exchanging information which helps the
    client access services on the Client Plan is
    Targeted Case Management.

   Note: School psychologists are not “mental
    health providers.” Neither are physicians who
    are not psychiatrists – even if they prescribe
    “psychiatric” meds.
                                                54
              Rehabilitation
          The key to Rehab is SKILLS

   The purpose of Rehab is to improve, maintain,
    restore, develop, increase, teach, etc. skills.
   Skills include daily living, thought-stopping, social
    & leisure, hygiene, self-soothing, cooking, meal
    planning, shopping, public transportation,
    relaxation, money management, skills to comply
    with meds, skills accessing and using services, etc
    THE SKILLS MUST ADDRESS IMPAIRMENTS IN THE LATEST
    ASSESSMENT, OR GOALS IN THE CURRENT CLIENT PLAN.

                                                       55
          Example 1: Rehab

  “Client wants money to buy a mini fridge for
   her hotel room. She found one for $103.28
   including tax. Arranged check.”
    No skills, no mental health intervention.
                “No Bill” service.

Billable: add “Reviewed & praised client’s use
    of comparison shopping skills which were
    previously discussed with her.”

                                                 56
            Rehab – Not Rehab
   Rehab means helping clients do things for
    themselves – NOT doing things for them.

Examples:
Yes: Reviewed budgeting and shopping skills,
  went to store with client, reminded her to follow
  her list and not buy impulsively.
No: Went to store and bought food for client who
  was unable to go because of agoraphobia.

                                                57
       Rehab and Medications

No: Observed client taking prescribed meds.
No: Went to client’s apartment to deliver meds.
  Watched client take meds because client is not
  able to take meds regularly without monitoring.

 Watching someone take meds is “No-Bill” -
  there is no mental health intervention.


                                              58
             Meds and Rehab

   Helping a client develop-improve-maintain
    medication compliance skills is a valid (and
    valuable) Medi-Cal mental health service.

   To bill for this activity, you need to document a
    clear set of activities in which can clearly help
    the client develop observable, measurable med
    compliance skills.



                                                   59
               Example:
     Very Basic Med Skills Protocol
1.   Where is your med cassette?
2.   What day of the week is this?
3.   Which meds are you supposed to take today?
4.   Open it. Do you recognize those meds? Are they
     the meds you’re supposed to take now?
5.   Do you need to take them with water? With food?
6.   Let’s check the med bottle. What problems are
     you supposed to watch out for? Do you think
     you’ve had any of those?
7.   Take your meds.
8.   Put your med cassette away.
                                                 60
           Med Skills Protocols

   Every program that actually does rehab with
    med compliance skills should develop
    “protocols” (lists of steps) to fit their clients.

   There must be different levels of protocols for
    clients with different levels of needs.

   It must be possible for clients to move from
    one protocol to another as their needs change.


                                                     61
            Words to Avoid
     Words have different meanings in
     English and Medi-Cal – be careful!
Administered medications is a medical term.
  It means you gave the client an injection.
  Requires a medicl license.

Monitored medications is also a medical term.
  It means you did a medical check for side
  effects and med interactions, and did other
  things that require a medical license.

                                               62
    A Special Twist: Group Rehab

   Group rehab must include individual feedback
    to the individual client re: something specific.

Yes: Group used discussion and role playing to
   enhance social skills when shopping. Reminded
   Jose several times about not talking loudly or
   shouting.

No: Group discussion and role playing to enhance
   social skills when shopping. Jose had some
   problems but participated actively.
                                                   63
     Not “Rehab” – Code “No Bill”
1.    Home visit. Client’s room was clean and she
      had adequate food. No MH intervention.
2.    Helped Chang maintain time management
      skills by reminding her of psychiatrist
      appointment. Appointment reminders are
      not billable.
3.    This staff went to the park with the clients to
      enhance their skills in connecting with the
      natural world. Ted walked quietly and calmly
      under the trees and enjoyed the experience.
      No mental health intervention.

                                                        64
             Rehab Examples
1.   Helped client improve dietary skills by helping
     her check food on hand and making a
     shopping list of things she needs to buy.
2.   Home visit. Kitchen was dirty with food spilled
     on stove and counters. Reviewed & helped
     improve cleaning skills by modeling and
     feedback.
3.   Helped client improve access to services by
     accompanying to Adult Ed art class, monitoring
     social and relaxation skills, and making
     suggestions.

                                                   65
           More Rehab Examples
1.   Visited school. Monitored interpersonal skills in
     class and on playground. Reviewed times when
     Billy did and didn’t use anger management skills
     well.

2.   Met with Mona and family, started teaching them
     anger management skills with “time-outs.”

3.   Initial meeting with Yoshi. Played board games to
     build relationship and start to help him improve
     skills in focusing and cooperation with others.

                                                     66
    Targeted Case Management

   Helping a client access needed services –
    not providing the service.

   TCM may include communication,
    coordination, and referral; making sure
    services are being provided.

   TCM must be related to the beneficiary’s
    mental health and part of the Client Plan
     – otherwise, it’s a “No Bill” service.

                                                67
               TCM Examples

No: Received, reviewed and placed into the
  ProPay chart a copy of the Trust Account
  balance.” No mental health intervention.
  Code this as “No Bill”

Yes: Helped client improve money management
  skills by going over bank statement and bills.
  Praised client for keeping bills in the “In” tray
  and keeping enough money in bank to pay
  them.
                                                 68
         More TCM Examples

No Filled out Medi-Cal renewal forms for
   client. No mental health intervention –
   doing things for the client. Code this as
   “No Bill”


   Stay tuned – the next slides are about when
   you can bill for helping clients with forms!


                                               69
           Filling Out Forms #1

If you fill out forms, it’s a Clerical Function.

But… Cognitive impairments due to schizophrenia
  prevent client filling out forms accurately, so
  staff met with client and completed Medi-Cal
  application with the input client was able to
  provide.
   The client is present & participates, staff has
    to help because of mental health
    impairments. Code as TCM.
                                                   70
            Filling Out Forms #2

    Helped client learn skills in filling out forms in
    order to access needed services. Reviewed
    Medi-Cal re-auth form with client, explained
    wording and meaning of questions, helped
    client complete form accurately.


   The client is present & participates, focus
    is on skills. If you really helped the client
    develop these skills, code as Individual
    Rehab.

                                                    71
     Even More TCM Examples

No: Went to Wal-Mart, bought small toys family
   can use as rewards for Angelina doing chores.
   No mental health intervention – doing things for
   the client’s family. Code as “No Bill”

Yes: Reviewed targeted behaviors with parents,
   when and how to use small toys as rewards.
   Could also be coded as Collateral.



                                                 72
        Crisis Intervention

There must be an acute need for services.
   Ask yourself: “If I had not provided this
    intervention, would the client have been at
    imminent risk of danger to self or others?”
   Does not have to end up with a 5150, but
    the situation has to be so acute that a 5150
    might be possible.


                                                  73
     NOT Crisis Intervention

Client here without appointment saying she
is in crisis. Reports "I'm doing much better
since I started Zyprexa but I’m still having
panic attacks." Appears anxious, speech
well paced, denies significant depression or
suicidal thoughts at present. Will keep appt
next week.
The client says it’s a crisis – that doesn’t
make it a crisis. No imminent threat.

                                               74
      Real Crisis Intervention
“Client depressed, possibly suicidal. Did
 suicide assessment. Passive SI, no clear
 intent, no plan. Willing to contract no harm for
 24 hours, will follow up tomorrow.”
“Client appeared agitated, angry. Shouting,
 many obscenities, hard to understand
 meaning. Stopped Risperdal about 2 weeks
 ago, hearing voices, thinks people are insulting
 him, wants to beat them up. Calmed client
 somewhat, picked up by CARES staff for
 followup.
                                               75
  Restricted Procedure Codes:
              LPHA
Assessment
Family Therapy
Individual Therapy
Group Therapy

  MD, PhD, LCSW, ASW, MFT, IMF, some
  RN, post-degree psych intern

                                       76
Restricted Procedure Codes

   See the training for Assessment –
              Coming soon!

 Follow the Rehabilitation guidelines for
           Therapy – except that a
   psychotherapeutic intervention that
 addresses targeted symptoms is required
         instead of a focus on skills.


                                       77
SPECIAL PROBLEMS

     Writing reports
     Transportation
Translating/Interpreting

If that’s all you did, it’s a
     NO BILL service

                                78
                  Reports

   Writing reports is a clerical function,
    therefore not a mental health service.

   Writing reports for Social Security, Social
    Services, Probation, CWS, … are
    Targeted Case Management – No Bill.



                                              79
               Transportation

    Just transporting a client to or from a service
    is a “No Bill” service.
                       But…
   If you provide a billable mental health service
    while transporting the client, the actual time
    spent on that intervention can be billed. Be
    sure to document the intervention fully, and
    only bill the time you did the intervention.

                                                80
              When “Transporting”
               Is Really “Travel”
If:
     The client’s mental health impairments significantly
      interfere with the ability to exchange important
      medical information with a provider–
                            and
     you take the client to the appointment so you can
      be present with the client during the
      appointment in order to help the client
      communicate
          that is covered by Medi-Cal as TCM.
                                                        81
      Example: Transportation
No: Met client at home, transported him to
   med appointment. I observed that client’s
   dress and grooming are appropriate and
   that client interacted appropriately.

Yes: Met client at home, transported him to
  med appointment. I reviewed relaxation
  skills and role-played communicating with
  the doctor since he often has anxiety when
  seeing psychiatrist. Transport time not
  billed.
                                             82
     Reminder: Tell the Truth
   Never use misleading wording to try to
    disguise the fact that you transported a
    client!

   If you drive a client to an appointment, don’t
    bill your time and say you “assisted the
    client in accessing an appointment” or
    “facilitated client’s access to a service.”

   Say that you transported the client and
    document as TCM – No Bill.
                                                 83
        Public Transportation
     Helping a client learn to use public
    transportation is Rehabilitation.
   Example: Client unable to use public
    transport alone due to fears and confusion.
    Reviewed skills client could use, then took
    bus with client to SSI and back home.
    Client expressed some anxiety while on
    bus, staff gave feedback and support.
    Praised client for success using bus but
    continues to need assistance.

                                                  84
       Translating - Interpreting
   If you just change words from one language
    to another, it’s a “No Bill” service.

But… If you actively participate in providing a
  service, document that.

   Met with doctor and family, provided
    interpretation. Helped client, parents, staff
    communicate. Explained cultural issues
    involved to doctor, family.
                                               85
    Restricted Procedure Codes:
               Medical

   Medication (MD/DO only)
   Medication Visit – Brief (MD/DO only)
   Medication Administration
   Medication Support




                                            86
Special Situations




                     87
        “No-bill” procedures
Targeted Case Management – Non-Bill
Client No Show
Client Cancelled
Staff Cancelled
   Even though these do not produce income,
    they must be documented. These events
    are important aspects of the client’s
    treatment record.

                                           88
         Always Code “No Bill”
   Email or voice mail messages
   Appointment reminders
   Services while client is in Jail or Juvenile Hall
   Tutoring or job training.
   Personal care – doing cleaning, laundry,
    bathing, grooming, shopping for the client


                                                    89
       Missed Appointments

Missed appointments are “No Bill” services
   Unless you provide a different service:
   Collateral services – exchanging
    information with a support person.
   Writing a letter to the client about what to
    do next, reminding the client about skills
    he/she has been taught, etc.


                                              90
 While the client is hospitalized

Document everything as “No Bill” except:
 Targeted Case Management
 for discharge or aftercare planning




                                        91
             Substance Abuse

    Services related to substance abuse are
     “No Bill” unless they have a clear focus
     on mental health issues:
     Mental health symptoms
     Mental health impairments
     Mental health treatment


                                           92
   “No Bill” Substance Abuse
“Client drinking heavily again. Probably needs detox.
  Citation for public intox. May be VOP, could go back to
  jail. Called Project Recovery but failed last 3 detox
  tries. Will talk with pgm mgr later re: what clt needs to
  do to get back in.”

“Met with client and group of other addicts. Discussed
  reasons they have used drugs and ways to stay clean
  and sober.”

    Important services – Important information.

               Code as TCM – No Bill.

                                                         93
Substance-Related and Covered
  by Mental Health Medi-Cal
“Client reports recent relapse with increased
 psychosis. Used after rejection by GF. Not
 taking Seroquel since relapse. Worked with
 client re: steps to take – will go into detox as
 soon as a bed is available, will see psychiatrist
 re: restarting meds ASAP.”

          Eval & Plan Development

                                               94
         Closing Cases
Closing cases is only a mental health
intervention when there is a clinical decision
or intervention such as referral to another
service or support system.

“Closed case,” “completed documentation
required to close file,” etc. are clerical only
and therefore “No Bill” services.


                                                  95
             Case Closing
        Mental Health Intervention
No: Closing case. No contact for 4 months.
No: Client no longer interested in services, so
  case closed.
Yes: Client no longer interested in services, so
  case closed. Explained to client how he can
  receive services in the future if he changes
  his mind.


                                                  96
   Consumer Concerns
Consumer concerns, complaints, requests, etc.
  require documentation and resolution.

Consumer concerns can be resolved:
  Through an informal, local, verbal process
  Through a formal, written grievance
  Through a formal state hearing process


                                            97
    Informal, Local Resolution

   Client verbally notifies staff of a concern.
   Staff resolve the client’s concern.
   The client is asked if the resolution is
    satisfactory and the client says “yes.”

        Each step must be documented.




                                                   98
     Formal Grievance Process

    A concern becomes a grievance and must be
     forwarded to QA whenever:

     The consumer makes a written complaint.
                         OR
     The consumer is not satisfied with a
      local, informal resolution.



                                             99
    Formal Grievance Process
   QA contacts the consumer to clarify what the
    consumer wants to happen.

   QA contacts the supervisor or manager (and usually
    other staff involved) to gather information.

   QA determines whether or not any laws, regulations,
    or department policies were violated.

   QA gives a written notification of the outcome to the
    consumer and the program.

   The consumer may appeal or request a state
    hearing.

                                                       100
              ADMHS
       Timeliness Standards

   Progress notes must be entered in a
    timely manner:
      Best practice is within 24 hours
      Each program manager sets
       standards for their program.

                                          101
     Questions?
   Quality Assurance
      681-5113 fax 681-5117


         Jeanie Sleigh
 jsleigh@co.santa-barbara.ca.us

         Ned Wilson
newilson@co.santa-barbara.ca.us
                                  102