Behavioral Health of Central Florida PLLC is a psychiatric clinic. We provide psychiatric medication management in conjunction with brief therapy. This guide will outline the procedures so the staff can educate current and future patients.
Behavioral Health of Central Florida PLLC aims to provide seamless access to care for its patients. Its goal is to provide access for mental health treatment that is strait forward and unconvoluted.
All new clients must complete documentation prior to having their first appointment made. They also must send in their insurance information, and insurance eligibility bust be checked (by EHR or billing company). Having this paperwork done prior to making first appointment greatly reduces no shows.
Clients can complete the paperwork and mail/email it back, drop off at office or preferably use online program (IntakeQ or EHR)
New documentation includes:
If patient is needing the provider to continue previously prescribed psychotropics especially scheduled medication, patient will need to send in previous documentation of diagnosis and prescriptions from previous prescriber. Or submit ROI and Behavioral Health of Central Florida
Behavioral Health of Central Florida staff can pursue records. If the request is for scheduled medications (I.e., Adderall or Benzodiazepines) diagnosis and prescription should be confirmed prior to arranging medication appointment. (this information can be learned by the medication sheet the patient fills out, checking the PMP, or having a screening questionnaire before that asks why the patient is looking for care).
Once paperwork is submitted and insurance verified (Behavioral Health of Central Florida PLLC) staff will contact the patient to schedule the first appointment.
The first appointment should be scheduled for 60 minutes.
Clients should come to first appointment 15 minutes before to ensure all information is accurate.
Patients will need to supply a copy of their current insurance card and their photo ID to be copied. If a telehealth appointment id and insurance cards should be electronically provided with intake packet prior to first appointment being scheduled.
Initial assessment will be 60 minutes. During initial intake provider will take a history of present illness. They will review PFSH and ROS from intake packet. Will obtain vital signs as necessary: at least 3 of (blood pressure, pulse, respirations, oxygen, weight, height, waste circumference). Will obtain an assessment of constitutional, musculoskeletal, and mental status exam. Develop and diagnostic formulation and provide treatment if necessary.
Optional components of the assessment: lab work up, genetic testing, UA or oral drug test or referral for further evaluation.
If a treatment is discussed, full informed consent will be given. Including what the risk of the intervention is, what this risk for not receiving the intervention and other potential options. Deciding on clinical intervention will depend on diagnosis, clinical appropriateness, and client decision.
Clients will be offered patient education and side effects list that will be printed off from an online source (i.e., Epocrates).
If medication is considered. It will be sent to the pharmacy of the client’s choice. Offering refill will be decided by the clinician. Patients need and preference will play into factor. But will ultimately be up to clinicians view on clinical appropriateness and risk.
90-day refills will be appropriate if medication changes are not foreseeable and client has been stable on medication. Also, safety of overdose and client’s safety should play a role and some clients may never be a good candidate even if med dose is not changing. This should be providers decision based off clinical data.
Behavioral Health of Central Florida PLLC values your privacy. When you provide your mobile phone number and opt in to receive text message notifications, we collect and use your number solely for the purpose of sending you appointment reminders, scheduling updates, and important service-related information.
Initial follow ups will be scheduled depending on patient need and clinician assessment. Ideally 4 weeks until client sees clinical improvement.
Follow-ups will be scheduled under 30-minute blocks. Clients will be asked to be at appointment time or logged into telehealth platform 10 minutes prior.
Ideally follow-ups will be scheduled around times when refills are due. As this allows continuity of care and also can make medication changes without too many previous dose pills being left over.
Scheduling will be done initially by staff for initial contact. New intakes will be given 1 hour for initial assessment. After that follow-up will be scheduled with provider during their appointment.
If client misses an appointment or needs to reschedule, they can call the phone number and reschedule.
If the patient is late, the clinician will decide whether or not the patient is seen. If clinician feels there is not enough time to safely evaluate the client, they will have the client reschedule. Later then 15minutes will not likely give the clinician enough time for an intake or follow-up.
Patient should cancel or reschedule their appointment 24 hours prior the appointment. If they miss this deadline, then they may be charged with a no-show fee.
If a client does not come to an in-person appointment. They will be marked no-show in the EHR. Staff will mail them a no-show notice. The no-show notice will include date of appointment, include how to remake an appointment also include local providers who the client can see instead in case the no-show is due to the client leaving services. Should include how much time can pass without hearing from the patient before the patient is considered discharged.
Late show fee: Card on file will be charged $50 dollars with no-shows. (This cannot be done with Medicaid). Decision to charge no show is up to the treating clinician.
After 2 no shows without appropriate reason for absence, the clinician may be discharged. Final decision to discharge is up to treating clinician.
For new intakes they will receive to reminder calls, 1 week prior to appointment and the day before appointment.
For follow ups they will receive reminder calls the day before.
Completing reminder calls 24 hours prior to appointments should be done if cancellations policy is strictly observed in order to give people appropriate time to reschedule .
Client should send refill requests to pharmacy for them to request directly from provider. Refill requests should be done 3 days prior to medication being completely out.
Alternative policy: have a text line specific for refills.
The decision to prescribe controlled substances is up to treating prescriber depending on their assessment and client’s diagnosis. Appropriate action should be taken to ensure client doesn’t have contraindications for this treatment including substance use disorder.
Methods to assess if patient does not have substance use disorder include but are not limited to: Checking PMP prior to prescribing and intermittently thereafter, Urine or saliva drug screen prior to prescribing and intermittently thereafter, administering Substance use questionnaires and inquiring about using habits. Taking history from a close family member like parent or Significant other.
Prescribing controlled substances to someone who concurrently uses EtOH, or marijuana is up to clinician discretion. Controlled substance should not be prescribed with concurrent SUD disorder, so ruling that out should be done by prescribing clinician prior. Also determining if treatment is appropriate with concurrent mj and etoh use. Clinician may choose not to prescribe controlled substance if in their clinical judgement it is inappropriate, contraindicated, or the risk is not worth the benefit.
Checking PMP will be done prior to treating someone with controlled substance or prior to treating someone with SUD. Checking for other reasons is up to the clinician. PMP should be continually checked intermittently during client’s treatment. This interval is up the clinician.
Discharging a patient is up to the treating clinician. Reasons for discharging a client may be for several reasons including no showing or late cancelling 2 or more appointments especially back-to-back or in a short period of time, requesting early refills or reporting using controlled substances too soon multiple times, being inappropriate to clinician or staff, making threats, violating controlled substance agreements, etc.
Clients considered for discharge should be notified by provider that the behavior in question should discontinue, this fact should be emphasized but threatening discharge is not necessary. For instance: if client misses a lot of appointments clinician can say, “it is really important that you come to your next appointment, or we may not be able to work together anymore”.
Policy of discharge should be in the consent forms and indicate 2 no-shows or late notices will result in discharge. The clinician may choose to not discharge but this language will protect their decision.
Only in some cases should a discharge occur without notifying a patient first. If the client was threatening or verbally abusive, a discharge letter can be sent without reaching out first. Though reaching out still may be important to avoid client coming in-person the clinic.
Discharges should be communicated to patient and patient should be given explanation by the treating clinician. A letter should be sent to the clinician notifying the patient of the final date of treatment, what medication they are on, and the last date you will refill. Also, should include 3 additional psych providers for client to reach out to that are local. It should include instructions on how to have records sent to future providers.
This should be sent to patients’ home via certified mail and an additional letter sent by traditional mail in-case client refuses to receive the certified letter.
After this date provider should no longer prescribe medication or communicate with patient unless they are accepting client back into their case load.
Copay will be due prior to the appointment. Patient can decide best way to pay copay. They also may decide to have it automatically pulled from card on file (this is the ideal way especially with telehealth). If the copay amount isn’t clear staff/provider should make an effort to identify the amount.!) check the card for amount. Often copay amount is written on the card. PMHNP’s charge the specialty amount. 2) Check when asking for benefits prior to patient being accepted, either by using EHR, billing software or billing specialist. 3) asking the patient what they think their copay is.
If copay amount is wrong and is overpaid, client can be reimbursed, or amount can be credited for next appointment. If copay amount is underpaid, a new bill can be sent to client or client can bundle with next copay.
If client has a high deductible, they will not be billed a copay. Their amount due will be understood when insurance sends the benefits explanation.
If client has unmet deductible the amount due minus copay will be billed to client once insurance sends explanation.
Medicaid clients will not be charged a copay or coinsurance
Patients may have a card on file. There will be an additional form signed by client permitting card on file. Card on file can be used for copays, co-insurance and late fees.
Medicaid clients will not have a card on file.
Documentation will be done using (the clinics EHR). Notes should be completely in a timely way but no more then 3 days after the assessment.
Submitted to insurance will be done via EHR or billing company. Insurance will not be billed until the note is completed.
Regular codes used for insurances. 99203, 99204, 99205, for intakes 99213, 99214, 99215, for follow ups 90833, 90836, 90838, therapy add on codes. For billing in person, insurance claims will include Diagnosis, Billing code, location of services 11 and price. For billing telehealth will include Diagnosis billing code Location of services 2, Modifier gt and price. (For Medicaid telehealth location 2, modifier 95) (for Medicare location 11 and modifier 95)
All staff members are trained on the following procedures. In case of an office emergency or disaster, staff members will immediately:
All employees shall be familiar with the disaster plans to assist in a safe evacuation of the building.
Evacuation of ambulatory patients:
When deemed safe, the Office Lead shall instruct employees in pairs to re-enter the building to perform the following tasks:
All employees shall be familiar with the disaster plans to assist in the event of an earthquake, and to inform employees of the proper safety procedures in the event of an earthquake.
Note: Earthquakes are usually followed by a series of smaller, yet potentially dangerous aftershocks. Continue to follow the procedures above to prevent possible injury.
All employees shall be familiar with the disaster plans to assist in a safe evacuation in the event of a fire.
The steps listed below are followed as quickly as possible in the event there is any uncontrolled flame or smoke in or near the office/building or its perimeter.