Office Policies

Front Office Operations

1.1 Proper Phone Etiquette

  1. ALWAYS answer the phone with a SMILE. “(Good morning/afternoon/evening) It’s a great day at Avant Psychiatry. This is _____ speaking how can I help you.”

1.2 Answering and Transferring Calls

  1. Answer the phone on the first 1-2 rings. Never allow any calls to rollover when you are available to take the calls regardless of that line they are calling from (except Spanish if you are non-Spanish speaking).
  2. Use your best judgment - we want to answer calls quickly but do not keep people waiting. Transfer the call to someone who can assist or take a message and call the person right back if you are with a patient or on another lengthy call.
  3. All correspondence to the provider or MD should be through telephone encounters.
    DO NOT BLIND HARD TRANSFER EVER     - When transferring calls make sure the person we are transferring the call to answer the phone and tell them we are transferring them a call.
  4. Every effort should be made to assist the caller on the first 1-2 rings without transferring again. Do not transfer a call to another office because it is “their patient”. It is the responsibility of every staff to assist each patient they interact with to their best abilities. “Don’t worry I can take care of that for you…”
  5. The patient asks to speak to a provider- let the patient know the provider is in session- ALWAYS take a detailed message. Do not transfer calls to the provider/therapist. Take the message to their office and follow-up.
    Ensure all telephone encounters clearly document all action taken and resolution.
    HANDLE all calls to completion- leave nothing unfinished.

1.3 Scheduling Policy

  1. New patients (NP) should be scheduled on the following days:
    Tuesday - Austell | Wednesday - Marietta/Kennestone | Thursday - Fayetteville
  2. Appointment Times: 7 AM - 12noon
    New patients should be scheduled 4 per hour
    Every attempt should be made to keep patients closely together in time.
  3. Therapy appointments are scheduled for at least 53 minutes and up to an hour. Therapy appointment frequencies are at the discretion of the provider based on the patient’s needs.
  4. Medication Management appointments are scheduled for 20 minutes.
  5. Patients are seen 2 weeks after their new patient appointment then monthly thereafter. Patients are also seen 2 weeks after any medication change.
  6. No patient should be seen twice in the same week unless urgent med changes.
  7. Schedules are filled aggressively throughout the day. Front staff MUST ask the providers if any patient has been added or removed from their schedule once schedules have been printed for the day.
  8. Any visit over 5 minutes is considered “billable” and patients should be added to the schedule when appropriate.

1.4 Front Desk Coverage

  1. There should be two admin staff up front AT ALL TIMES - except when only one is scheduled. Breaks should not be taken at the same time as another admin staff or manager. Under no circumstances should the front desk be left unattended.

1.5 Interpreter Services

  1. Patients that require an interpreter (Spanish only at this time) should be documented in their chart and on each visit in the comment section. When scheduling a patient confirm that a Spanish-speaker will be available for that patient the day prior. Offices should utilize staff in the office to translate before calling another office to do so by phone.
  2. If a patient asks for interpreter services for another language let them know our office does not currently provide that service.
  3. If a patient comes with no interpreter available at any office. Use Google translate (if needed) to tell the patient they will need to reschedule.
  4. Inform patients that insurances are required to provide translation services.

1.6 New Patient Calls

  1. New patient calls are directed to a designated line (ext. 110). If that line is occupied, it will ring to other offices. New patient calls should be captured fully and uploaded into the Google drive onto the New Patient Spreadsheet immediately after or during the call.
  2. Confirm we accept the patient’s insurance plan. Go ahead and schedule the patient and add them to the new patient spreadsheet.
  3. FOR MEDICAIDS ONLY: medicaid patients must be sent the new patient paperwork and have the completed forms sent back to us along with a copy of their ID and insurance card before being able to get scheduled. It is advised to get in touch with our new patient coordinator to make sure medicaids are handled properly. 
  4. After their insurance has been verified, the patient is contacted within 48 hours informing them of their benefits and/or patient responsibility.
  5. If a patient is unable to pay the contracted rate, offer the self-pay rate (see 2.9).
  6. Explain how our new patient days work and ask them which location would be most convenient for them. They can opt to do follow-ups at any location.

New Patient Spreadsheet

  1. Patients are highlighted in yellow when added to the spreadsheet. This lets the insurance department know that their insurance needs to be verified. The insurance department then changes the color to green once verified.
  2. Purple: Error with insurance or billing needs more information
    Red: Insurance not in network
    Pink: Inactive patient.
  3. Always get a reference ID for the call and answers to all questions. Create a memo in eCW with all of the mental health benefit information under the insurance tab as well as in the billing alert pop-up for easy access to benefits. Ensure reference ID is in memo as well as any limitations on services/billing codes/or prior authorizations needed.

1.7 Insurance Verification Process

  1. Insurance verification is completed as a courtesy. We simply relay information given to us from a patient's insurance company. AVANT PSYCHIATRY IS NOT RESPONSIBLE FOR ANY INCORRECT INFORMATION THAT MAY BE PROVIDED TO US. If a service is provided that is not covered by a patient's insurance company, they will be the responsible party at the time of service. (see new patient packet)
  2. Currently 1-2 people monitor insurance verifications each day.
    Insurance Verifications ALWAYS start on the portals. Insurance companies are called for benefits as needed.

Financial Policies

2.1 Payments and Refunds

  1. Payments are due prior to service being rendered. Our office does not provide refunds for visits once the visit has begun. A patient can ask for a refund if the visit has not yet started or if they were not seen. Memo and process accordingly.
  2. We only accept debit and/or credit as a method of payment. Verify the card belongs to the patient or that they are accompanied by the card holder. Minors paying with their parents’ card that is listed on the HIPAA form is acceptable.
  3. If a patient ever formally disputes a valid charge, they will be discharged for non-compliance of office policies.
  4. If a patient can not pay for the visit a promissory note can be completed by the patient. All owed fees are due prior to the next visit. Only one promissory note can be completed in a 90 day period without additional approval.
  5. Front Desk staff may offer a promissory note up to the amount of $60, Office Leads may approve any patient responsibility above this amount.
  6. Promissory notes can not be used on new patient appointments.

2.2 Sliding Scale-Self Pay

  1. Current self-pay rates are $350 for a new patient, $200 for licensed therapists, unlicensed is $75, interns are $35 and $150 for medication management only.
  2. Self pay scales must be approved by management. New patients can be reduced to $150, LICENSED Therapy is $150, and medication management is $75
  3. Self-pay does not get billed to insurance and will not cover deductibles.

2.3 Balances Due Policy

  1. Payments and balances are due at time of service, not after services rendered.
  2. Patients with a balance must make a good-faith effort to pay towards their monies owed. If a patient needs a payment arrangement to pay off a balance, offer to pay off the balance within 2-6 visits. Not to exceed 6 months.
  3. Payment arrangement forms should be completed and filed with a memo on file.
  4. Patients should always have this matter discussed in private (not at the front window).

2.4 Financial Assistance Forms

  1. Patients unable to pay any or part of their patient responsibility MUST complete a financial assistance form to waive or reduce their co-pay.
  2. Always offer a reduction as opposed to waiving the entire co-pay. Ask the patient (in private) if a reduction would work for them as this helps set compliance.
  3. Any co-pay over $20 must be checked by office management. Our office must still be reimbursed at minimum our self-pay rate with the absence of the copay for approval.
  4. Medicare patients who cannot pay their 20% (or less) are automatically eligible for the financial assistance waiver (must be completed and documented yearly).
  5. Patients must maintain compliance and cannot no-show as stated in the financial assistance form.

2.5 Insurance Discrepancies

  1. Never argue with the patient on insurance discrepancy, simply document and monitor.
  2. Patients often dispute the patient responsibility owed. Insurance also gives a disclaimer on all calls that the information is not a “guarantee of payment”.
  3. We monitor billing reimbursement closely. If billing comes back and the patient owes more or less than what we were told, their account will reflect that, and the patient's responsibility will be updated on the following visit.
  4. Inform the patient if the insurance determines they are responsible for the difference it will become a balance and be billed to the patient.
  5. Financial assistance forms are available for patients stating they are unable to pay. (See above for rules).
  6. Every effort should be made for the patient to pay the amount stated by their insurance. Inform the patient that they can keep a receipt and file with their insurance for reimbursement if they believe the information to be inaccurate.
  7. It is also important to mention that we are a SPECIALIST and a MENTAL HEALTH office because patients typically pay different prices and have different coverage at other offices. (Primary care offices are usually covered at low cost while we are not).

2.6 New Insurance

  1. Patients should update us on updated or new insurance ahead of their visit. Should a patient fail to do so they will need to allow up to 24 hours for us to verify their new insurance.
  2. Best judgment should be made here, if a patient is in office on the day of their appointment every effort should be made to get the patient’s insurance verified. Especially if it is accessible via Gammis/Availity. If it is after 2pm and requires a call to the insurance, the patient should reschedule.
  3. Inform the patient it may be several hours to verify and offer to reschedule if needed. In the future they should update us as soon as their insurance changes to prevent delays (refer to policies in patient packet).
  4. Patients with new insurance or eligibility issues will need to reschedule if they have a therapy appointment.

Appointments & Patient Flow

3.1 Telehealth Visits

(Please See Informed Consent in Patient Packet for Further Info)


  1. We offer telehealth visits via Healow. Patients having a difficult time accessing virtual visits pay be allowed care by phone on a case-by-case basis and must be properly documented.
  2. Telephone visits are not appropriate for complex patients, patients on controlled medications, or patients that providers deem unfit.
  3. Patients that are unable to access virtual visits repeatedly should be asked to come into the office for their visits.
  4. NOT ALL PATIENTS are eligible for telehealth including:
    - Those whose insurance does not (or no longer) allows telehealth visits
    - Those patients who are not responsive to telehealth treatment
    - Patients with issues of non-compliance or high complexity
  5. Most children under 8, couples, families, and first-time therapy visits should be made in person unless given the approval of the provider.
  6. Providers that feel their patient is not suitable for virtual visits should notate in the note, add a memo, and notify the front desk to “High Alert as in office only”

3.2 No Show Policy

  1. A same day cancellation is considered a no show no matter what. A $60 no show fee is automatically accrued when an appointment is marked as such (excludes Medicaid & CMOs).
  2. If a patient is new to the establishment and “no shows” on new patient day we call the patient and offer to reschedule them while informing of No Show Policy and the fee (Any form of Medicaid is an automatic discharge on second no show and we will need to refer out).
  3. Many patients are not informed of their discharge after missed appointments.
  4. Established Patients get one no show fee waived per year:
  5. 1st No Show - Ask the patient if they can do telehealth (if applicable) or reschedule for the same or next day (with the same provider) to avoid the no-show. If they have not called or are not able to do so, inform the patient of our $60 No Show Policy. Let them know we waive only one per year. Counsel them on the importance of keeping visits for compliance.
  6. Patients are charged a $60 fee before rescheduling an appointment after a no-show.
  7. Future therapy visits will be canceled after the second no-show and can only be rescheduled once the patient pays the no-show fee.
  8. Patients cannot schedule therapy once they have no showed two times, they will be on the fill list that the therapist has for a probation period (90 days - patient is also not allowed to no show to med management appointments)
  9. Patients can also opt to pay the self-pay rate to pre-pay for visit in order to get back on a therapy schedule before the 90 days.
  10. Patients are discharged at 3 no shows in a year and are marked inactive.
  11. Ensure discharge letter has been mailed to the patient.
  12. New patients that no show their initial visit must pay a $60 no show fee in order to be scheduled again. This does not apply to medicaids, medicaids cannot reschedule with us if they no show their first visit with us.

3.3 Late Appointments

  1. We should notify the patient at the appointment time (or within 5 minutes if the provider is running late).
  2. Providers should make every effort to notify front staff if they are running late so that they can notify the patients if they are more than 5 minutes behind.
  3. There is a 5-7 minute grace period for med management visits. After that patients will be asked to reschedule.
  4. We allow a 15-minute grace period for late therapy appointments. After 10-15 minutes patients may be asked to reschedule or have a reduced therapy visit (if the slot has not already been given to another patient).
  5. Patients should be called at their appointment time to inquire if they are on their way by provider (if therapy visit) and front desk (if med mgmt or new patient).

3.4 Inactive Patients

  1. Patients are marked inactive after 90 days of no visits and the front desk has attempted to contact the patient 3 times. Document via memo.
  2. If an inactive patient wishes to be seen again the admin staff must confirm the patient's account notating the following:
  • No balance due
  • No memos regarding issues or non-compliance
  • No more than 1 no show
  • Patient is not on Benzos

Medical Records & Compliance

4.1 Medical Records Requests

  1. Patients have a right to access their medical information and records through healow.
  2. If anyone other than the patient or proper organization (listed in patient consent) is requesting medical records, we must consult the HIPAA or Release of Information form and if they are not on there, we let them know that we are unable to send over the medical records.
  3. If the patient or someone on the HIPAA form, or proper organization is requesting medical records, we inform them that it costs $1 per page but it’s free if sent electronically. Medical record requests will be completed within 3-5 business days.
  4. Medical records and audits should be PRINT and GO and should not require further note review by anyone. Providers should write notes in a way that is professional, accurate, and should be worded in a way that is non-offensive. Records are not legally or ethically supposed to be altered after 24-48 hours except for adding addendums.
  5. Always place a memo on a patient’s chart after submitting records.

4.2 Release of Information (See Form)

  1. Documentation is required in order to speak to or release ANY information regarding a patient to any other individual or organization.
  2. Must be signed by the patient and kept on file with a memo in the chart.

4.3 Informed Consent

  1. The patient MUST sign informed consent, consenting to treatment before they can begin their visit with a provider (located in the new patient packet).

4.4 HIPAA Policies

  1. Privacy, security, and integrity of protected health information. Never expose patient information/paperwork to other individuals. Refer to patients by either account number (internal) first or last name - never both.

4.5 Confidentiality

  1. Patient privacy is of the UTMOST importance. Protect this diligently.
  2. Do not access patient records and/or their chart unless necessary to do your job.
  3. No staff should discuss the reason for someone’s visit or the details of that visit unless clinically necessary.
  4. If you know a patient personally please inform your supervisor immediately so they can be made aware. The patient’s chart should be blocked from your view.

Prescriptions & Medication Policies

5.1 E-Rx

  1. We electronically prescribe all medications. Patients must choose one pharmacy to receive all medications and update us if this changes. Providers should confirm the pharmacy each time they prescribe medications. Our office will not resend to another pharmacy once the Rx has been sent.
  2. If a patient’s pharmacy is out of medication and we MUST resend to another pharmacy. The patient must first call the new pharmacy to confirm they have the medication and provide that pharmacy information to admin staff. Our office will need to call the previous pharmacy to confirm it has not been picked up and then cancel the prescription. All of this MUST be documented in a memo.

5.2 Printed Prescriptions

  1. We do not print prescriptions except in VERY rare circumstances.
    DO NOT OFFER THIS OPTION!
  2. Dr. Justin is the only provider authorized to sign printed prescriptions therefore these patients will need to either schedule when he is in office or schedule to pick up after he has come in to sign them on new patient day. Please inform the patient appropriately. Document if picked up later.

5.3 Controlled Medications Monitoring

  1. All patients on controlled medications are subject to monthly medication monitoring either by urine sample or oral fluid.
  2. Suboxone requires patients to complete MANDATORY monthly medication monitoring.
  3. A provider can also request one if they desire or have any reason to suspect misuse.

5.4 Prescribing Out of State (Temporarily)

  1. If a patient goes out of the state temporarily but maintains a resident of a state that Dr. Justin is currently licensed, they may temporarily receive medications (no more than 90 days). Must have a telemedicine appointment and not be on any controlled medications.
  2. Patients needing out of state visits requiring more than 90 days of time would require MD approval.

5.5 Patient Permanently Moves

  1. We cannot continue care when a patient no longer lives within a state that Dr. Justin is currently licensed – Georgia, Utah, Virginia, Missouri, California, Texas, New Mexico, North Carolina.
  2. Verify with management if a patient could become a patient for clearmind.

5.6 Medication Monitoring (UDS/Mouth Swab)

  1. Required after prescribing to ensure the patient is taking medication. Also, periodically as needed and/or required by the DEA.
  2. Medication monitoring should take place when and if the provider feels their patient is not taking controlled and/or non-controlled medications as prescribed.

5.7 Benzo Policy

  1. Our office will not initiate prescriptions of Xanax or Klonopin (benzodiazepines).
  2. If a patient comes to our organization on these medications we will confirm on PDMP and only continue on the currently prescribed dosage. Dr. Justin will not increase dosage and typically will only prescribe enough to taper the medication.

5.8 ADHD Policy

  1. Patients must be either previously diagnosed or prescribed to continue ADHD medication (confirmed by records or PDMP).
  2. For us to begin prescribing ADHD medication, an ADHD test is required. It is $100 and not billed to insurance. (Patients can get the receipt and request reimbursement if covered by their insurance).
  3. The provider should inform the patient that they need to complete the ADHD test in an appointment after completing the ADHD pre-screening.
  4. The provider should then inform the front desk as they are checking out. The front desk should have the conversation with the patient about fees associated with the test and the options for taking the test either in the office or at home. The front desk should then collect payment, add the patient to the ADHD spreadsheet, email the link to the patient or set up a time for the patient to come into the office to complete the test.
  5. Once the test has been completed, the results will be interpreted and sent to the provider to discuss during their next appointment.
  6. ONLY a manager can waive ADHD testing fee.

5.9 Lab Policy

  1. We no longer offer in house labs for new patients. The patients must have lab orders created by the provider and referred to either Quest Diagnostics or LabCorp. All patients on controlled medications must have a UDS/mouth swab for medication management on file after being prescribed and will have a base line of labs. The patients who are currently prescribed Depakote and Lithium are required to have a baseline of blood work.
  2. We do not bill out for lab work. This is handled by either Quest Diagnostics or LabCorp where they do the lab work.

5.10 Suboxone Policy

  1. Suboxone is the most highly regulated medication we prescribe.
  2. It requires medication monitoring and counseling monthly. Counseling can be supportive therapy but must be well documented.
  3. Patients who test positive for illicit drugs have one month to test negative for illicit drugs or we will no longer be able to continue treatment.

5.11 Prior Authorization (Medication)

  1. Providers should explore well known medication options for patients first to avoid potential prior authorizations for medications. PAs are often time consuming and may not always result in an approval.
  2. Always document failed medications when exploring new medications.
  3. Often patients will not be informed by the pharmacy that a PA is required. If insurance does not approve prescribed medications, an alternative medication must always be offered FIRST.
  4. Once PA is approved, the patient is called and informed by the pharmacy, and a memo is documented. If denied, patients will be given an alternative medication or must self-pay for meds. If a patient wants a different medication, another appointment must take place to discuss other options.

5.12 Lost Prescription

  1. Patients that have lost or have had their non-controlled medications stolen can get another prescription. If they are within one week of their next appointment, they will need to schedule a new visit. We will only fill a lost/stolen prescription one time. Admin must document in a memo.
  2. Patients that have a lost/stolen controlled medication can get another prescription only if they provide a police report (DEA requirement). Admin must document in a memo. Inform the patient that they will also need to provide the police report to the pharmacy who will only fill at their discretion.

5.13 Illicit Drug Use Policy

  1. Our office does not have an opinion on THC usage and does not discharge patients solely on illicit drug use. Results from lab work or UDS that reports illicit drug use will however affect the prescribing of controlled medications and may require close monitoring and counseling services in order to continue care. Providers are to use their discretion on appropriate treatment plans based on severity of drug use and efforts of compliance.

Patient Compliance & Conduct

6.1 Non-Compliance Policy

  1. Patients are subject to discharge based on non-compliance. Non-compliance includes violating office policies or refusing the prescribed or recommended treatment (to include taking medications, seeking referrals as recommended, or participating in therapy as requested by clinicians)

6.2 Discharging Patients

  1. If any patient fails to comply with one or more of our policies, our practice will discharge the patient.
  2. Our office reserves the right to discharge a patient for failure to abide by our policies and/or for any of the following but are not limited to: Abusive language or behavior directed towards staff, disruptive behavior that upsets or terrorizes other patients in the clinic, destructive behavior that damages clinic property, excessive or aggressive use of profanity, habitual disregard of an advised plan of care, and misuse – or the suspicion of misuse – of prescription medication or request to commit insurance fraud.
  3. If a patient is noncompliant with their visits and/or medications, we will discharge them. If they refuse our treatment plan this creates a liability and we then discharge them. Discharge letters should be sent to all patients at time of discharge via email and the postal service. Documentation should be kept on file and a memo must be created. The front desk should generate a weekly list of patients needing to be discharged and provide it to Dr. Justin/JoAnna on a new patient day.

6.3 Aggressive and Unruly Patients

  1. Aggressive and unruly patients should be added to the possible discharge list and discussed with Dr. Justin. He may then request to see the patient when he is in office to evaluate further. Many of our patients suffer from behavioral disorders but excessive rude and disrespectful patients will not be tolerated in our clinic.
  2. If a patient becomes threatening, physically aggressive or the staff is fearful that a patient may cause harm to themselves or others please get another person involved (manager or clinician if possible), use the safe word and call 911.

6.4 De-escalation Policies

  1. All staff are expected to recognize early signs of agitation or distress in patients and to respond with empathy, professionalism, and appropriate de-escalation techniques. Physical intervention should not be used unless there is an immediate risk of harm to staff or other patients. Patients are subjected to being discharged should they become threatening and/or violent.
  2. Use verbal de-escalation techniques such as active listening, calm tone of voice, and non-threatening body language. Patients exhibiting signs of distress will be offered a quiet space and the opportunity to speak with a clinician who is available.
  3. If a situation escalates beyond verbal intervention, staff will follow established emergency protocols, including contacting emergency services as appropriate.
  4. All incidents involving behavioral escalation should be documented and further reviewed to ensure appropriate follow-up.

Letters, Forms & Documentation

7.1 Office Policy on Letters

  1. When patients request letters for general information regarding their care, we should always offer a clinical summary that can easily be printed from the EHR or e-mailed.
  2. Front desk administration is only responsible for creating general letters regarding appointments, diagnosis, and prescriptions.
  3. Some fees may be applicable depending on the need.

7.2 Emotional Support Animal Letters

  1. Avant Psychiatry does not offer emotional support animal services or paperwork affiliated with this service, but we will give resources that will help with finding the right information to move forward with the process of seeking an emotional support animal or getting paperwork for it.
  2. We no longer offer notes.
  3. Please refer to the emotional support animal resource letter and provide to patients when they have questions.

7.3 Time Off Work Letter

  1. Dr. Justin may approve for a patient to take time off of work, typically only two weeks. Anything beyond this could fall into FMLA/STD.

7.4 Paperwork/FMLA/Short Term Disability

  1. Our office no longer completes FMLA/STD paperwork. Provide resources to patients as needed.

7.5 Surgery, Military, Other Clearances

  1. Surgery clearance letters are $150 for the documented report or the completion of paperwork. The patient must also pay for the visit.
  2. We offer bariatric clearances regularly (requires only one visit) unless denied clearance. Dr. Tuggle (SRMC) referrals do not require the $150 fee as we receive a majority of her patients for bariatric clearance. Please inform the patient that other surgery clearances may require more than one visit and require MD approval.
  3. Military clearance letters and other clearance letters (approval to drive, approval to manage own money etc.) must be approved by Dr. Justin.

7.6 Court Paperwork/Appearance/Statement Requests

  1. Every effort should be made to avoid court paperwork or providing statements to be used in court. Please consult your supervisor for these requests. Our office does not make court appearances unless required by subpoena.

Special Patient Populations

8.1 Minor Patient Care

  1. Patients under the age of 16 must be accompanied by an adult for their appointment. Forms should be on file for all minor children that they are accompanied by their legal guardian to their visit. Children cannot receive care unless approved by their legal guardian.
  2. We do not get involved in custody cases or provide letters in support or in opposition of cases involving “fit parenting” as this is not our area of expertise. Minors must be accompanied by a guardian for medication changes and to initiate care at the first visit.
  3. Minors on controlled medications must be present during their visits. Our office generally does not see patients under the age of 6 unless approved by Dr. Justin.
  4. Many therapists and providers are only comfortable seeing and treating patients above this age
  5. It is difficult to find medications for children under the age of 6 years old that will be covered by their insurance -- this falls within FDA guidelines
  6. If a 5 year old is required to be evaluated prior to returning to school due to behavior we can assist in these situations. In these situations it's important to make sure that the provider is comfortable treating the patient at that age and that the parent understands medications are not guaranteed to be prescribed or covered by their insurance.

8.2 Patients Requesting Only Dr. J

  1. Our follow-ups are generally seen by our mid-level providers which allows more flexibility with scheduling and more time with the provider. Dr. Justin monitors all patient’s treatment and progress closely with the Nurse Practitioner and Physician Assistants.
  2. However, if the request is due to a complaint or because the patient states they just want the Dr. to review meds, questions, etc. inform the patient of Dr. Justin’s limited schedule. Let them know they may have to wait 15-30 minutes for that follow-up visit due to his busy schedule on new patient days. ALWAYS have a student or scribe document with Dr. Justin for any new patients or follow-ups.
  3. Except when suggested and approved by Dr. J - patients will then be rescheduled with the appropriate mid-level provider.

8.3 Patient Requests to Switch Provider

  1. This is the patient’s preference and is allowable at our organization. Gather information from the patient to help find a more appropriate provider to be seen either in office or virtually.
  2. When providers refer to another provider or therapist in our organization please send a HIPAA compliant email in regard to transitioning care of that patient and the reason for doing so.

8.4 SSI/Disability Medical Record Requests

  1. Print medical records and submit them with a barcode attached. Put on records request list. Payment of $15 will be made by DDS to Avant by mail.
  2. If patients request information about this request and it is not updated on the google sheet for paperwork- inform the patient to contact their representative to have them fax the request with the barcode. Without the barcode the records will not be received.

Emergency & Safety Protocols

9.1 Safe Word/Phrase

  1. If you are in danger or feel fearful and feel like you need someone to come into your office or work area immediately. Message via WhatsApp or to staff directly: SOS if someone needs to also call 911 immediately - SOS 911
  2. If you receive a call or are told “Do we have any Powerade?” Please report to that room immediately. This is the phrase used when we cannot speak freely and need help.

9.2 1013 Policy (Columbia Suicide Risk Assessment)

  1. The requirements for 1013 follow three guidelines. If the patient meets the guidelines, please have someone call 911 immediately while someone remains with the patient. 
  2. Is the patient currently suicidal?
  3. Patient has to have made a suicidal statement during the visit to the provider
  4. Patient has to refuse to plan for safety 
  5. Refuse to consent for family to come and watch them and secure weapons
  6. Refuse to talk through their suicidal thoughts and retract their statement
  7. Is the patient homicidal?
  8. Patient has to make a threat to an identified person during the visit to the provider
  9. Patient has a plan to kill or hurt an identified person 
  10. The plan doesn’t have to make logical sense
  11. The patient has to refuse to plan for the safety of that person. 
  12. Refuse to consent for family to come and watch them and secure weapons
  13. Refuse to talk through their homicidal statement and retract their statement
  14. Is the patient currently a danger to themselves or others via psychosis? 
  15. Patient has to be actively psychotic during the visit
  16. Patient has to present a threat to themselves, others, or their environment due to psychosis
  17. The source of psychosis doesn’t matter: Drugs, mental illness, flashbacks
  18. Patient has to refuse to plan for safety
  19. Refuse to consent for family to come and watch them and secure weapons
  20. All non-clinical providers need to consult with their supervisor or manager before going through the 1013 process. 1013 Process should be well documented via memo’s and patient’s chart.
  21. If a patient calls threatening to harm themself or others- keep the patient on the line.
    We always call any individuals on HIPAA or authorized as emergency contact to inform them.
  22. Who Can SIGN a 1013 for a patient? Licensed Therapists and Dr. Justin can sign and send 1013 forms to an office when required.

9.3 Emergency (Crisis Calls)

  1. When patients call stating it is an emergency or crisis visit- you must ask if they are in immediate danger? Also ask “Are you in danger of harming yourself or someone else?”
  2. If so, please ask the patient to call 911 or provide crisis line information. Our office will also notify 911 either for 1013 or Wellness Check Make sure to get the patient's information and current location to provide. Document next steps taken- get a clinician or manager involved if you feel the situation is beyond your control.
  3. If the patient is not in danger- let them know the provider will call them back within 24 hours. Follow office policies for phone messages. Again, if a patient states they are truly in crisis or danger - have them call 911 and MAKE SURE this is well documented in the memos.

9.4 Mandated Reporting

  1. Mandatory reporting is when the law requires you to report known or suspected cases of abuse and neglect. It mainly relates to children but can also relate to adults if the person involved is living in a residential service.
  2. Child Abuse and Neglect Reporting (DFCS)
    Report by phone. Call Centralized Intake at 1-855-422-4453. A report can be made 24 hours a day and 7 days a week.
    Report by email. E-mail the completed Mandated Report attached to CPSIntake@DHS.GA.GOV.
    Report by FAX. Fax the completed Mandated Report to 229-317-9663.

Programs & Services

10.1 TMS Process and Requirements (Transcranial Magnetic Stimulation)

  1. TMS is a non-invasive magnetic therapy for treatment resistant depression. Any patient that is diagnosed or has symptoms of depression is required to have an PHQ9 completed in their first visit or upon being diagnosed with MDD.
  2. In order to qualify for TMS a patient must have been prescribed 2 failed antidepressants. Medicaid insurance is not accepted for this service.
  3. TMS requires a mapping on a new patient day - 36 visits - 19 minutes each. They cannot miss more than 4 days in a row, or it will be ineffective.

10.2 Spravato Process and Requirements

  1. Spravato is a self administered nasal spray for treatment resistant depression. Any patient that is diagnosed with treatment-resistant depression (TRD) or major depressive disorder (MDD) with acute suicidal ideation/behavior.
  2. In order to qualify for Spravato a patient must have been prescribed 2 failed antidepressants.
  3. Medicare, Tricare, Champva and some UHC plans do not cover Spravato.
    Spravato requires patients to come in the office for 2 hours and be monitored. 
  4. Patients are not allowed to operate any moving vehicles until the next day after getting 8 hours of sleep. Staff are required to verify the patient has transportation to get home.

10.3 Genetic Testing Services

  1. We do not offer Genetic Testing.

10.4 Therapy Procedures

  1. First Session: Preferred in office visit to develop rapport and set treatment goals
    Documentation: Must include modalities used, at least 2-3 sentences (subjective and objective) that captures therapy goals or what patient is working on or discussing in therapy. SHOULD ALWAYS include the start and end time on therapy.

10.5 Therapy Schedule (Fill/Wait List)

  1. We currently do not have a fill/wait list.

Billing & Insurance Operations

11.1 Medicaid PA’s (Visits)

  1. Many SSI Medicaid patients require authorization for additional visits as they are only allowed 10 per year for all medical office visits.
  2. Staff will add Medicaid patients to the PA list once they schedule as a new patient. Admin will request more visits via Gammis portal and add PA number to Medicaid PA list. Biller will add this to future claims.

11.2 Billing Process

  1. Provider Generates Superbill, Biller reviews superbills and creates charges, claims are “scrubbed” by our EHR for errors and submitted to insurance carriers, reimbursement or denial is received anywhere from 2 weeks- 60 days (most take 30 days), denials are worked by the biller and remaining balances are billed to patients.

11.3 Insurance: Special Cases to Be Aware Of (Billing)

  1. Peach State does not pay 90838. Therapy visits must be billed without med check (as 90837) or as supportive therapy with med check (90833+ 99214)
  2. Do not schedule for individual therapy without notifying patients that they will need therapy only.

Administrative Systems & Workflow

12.1 Google Sheets/Google Drive

  1. Are a requirement for all admin staff to use regularly for the following:
    New Patients, ADHD testing, Medicaid PA’s and Medication PA’s
    All master forms and letter templates should be available on the drive.

12.2 Incoming Referrals

  1. Typically received via fax and forwarded to the new patient coordinator to reach out the same day (within 5-10 minutes of receiving referral).
  2. Referral sources should be added to the patient's chart (especially if PCP).
    Incoming Referral can also be checked on the R jellybean in ECW.

12.3 Outgoing Referrals

  1. Psychological evaluations, primary care/neurological: We complete a referral form, send it via fax (if able, we also provide a copy to the patient).
  2. Also provide other options in the patient’s area just in case the original office is unable to see the patient. References are found in each resource binder located in reception areas. Document.
  3. Other resources can be found and provided in the resource binder.

12.4 Pharm/Lab Reps

  1. Must speak to the lead and must book lunch.
  2. We do not accept meetings with reps for labs at the current time.
  3. Please get samples, patient information, and co-pay cards if available.
  4. Do not allow pharmaceutical reps to stock their samples themselves as they are not allowed to access the sample cabinet/closet.

Staff Policies & Expectations

13.1 Attendance Policy

  1. Call Outs: Two in 30 Days, Four in 6 months, Six in 1 year
    Excessive Tardiness (Six times in any 90-day period, 10 minutes late)
  2. No Call – No Show
  3. The above violations are subject to termination (doctors notes and documented absences will be taken into consideration with decision making).

13.2 Perfect Attendance

13.3 Working Virtually (Working from Home)

  1. Although our organization is working to provide more virtual working opportunities, we are currently not set up to allow full-time work from home options for our staff. We review partial work from home hours to days on a case-by-case basis. Under no circumstance should a staff member elect to work from home on their own accord due to having doxy patients scheduled at particular times or due to convenience for the staff member. This must be approved in advance. All work from home hours must be pre-authorized by Andrea (HR manager) or JoAnna (Director). Should an emergency situation arise requiring an employee to need to work from home please reach out to Andrea immediately for authorization. We will make all reasonable efforts to accommodate as long as it does not affect patient care or regular clinic operations.
  2. Dr. Justin has personally requested all work from home be authorized by him via HR Manager or Director. Therefore, if not authorized and a staff member works from home when scheduled to work in office, they will not be compensated for this time and receive a performance review or verbal/written warning. If work from home and schedule gaps are not filled beyond one hour, you will be docked for that missing time. Patients who are not able to do virtual visits due to patient needs or insurance requirements may result in gaps on schedules. Please work to fill these missing gaps or offer administrative assistance to offset these openings. We must pre-approve therapy virtual days and view therapeutic environments for privacy and appearance.
  3. Any admin staff authorized to work from home must provide documentation for hours spent when unable to be tracked eCW and RingCentral.

13.4 Employees and Family Members Engaged in Services

  1. As a general rule we do not treat employees or their families for therapy or prescribe medications as this is considered unethical.

13.5 Resource Binders

  1. Please utilize resource binders to review office policies and provide patient resources. These are available in every office.

Roles & Responsibilities

14.1 Front Desk Staff

  1. FD1 should be able to make payment arrangements and promissory notes, view patient ledger in regard to payments, call patients to discuss schedule changes, review google sheets and memos to provide up to date information, coordinate with other offices for patient or clinic needs, be well versed in office policies and procedures and communicate this effectively with patients and staff.
  2. FD2 should be able to problem solve all of the above as well as: medication issues as it relates to pharmacies and PDMP and patients and staff.
  3. FD 3 is back up for both FD2 and FD1. All calls will go to FD3 first and then go to FD2, and FD1. 
  4. Admin 2, and 3 escalates other patient issues to office manager (administrative), therapy supervisors (as it relates to their patients), prescriber (only if relating to medication questions). Billing issues are given to the lead who will escalate to the billing manager if unresolved. Patients who are non-compliant with visits and no shows should be given to the lead for potential discharge. Communication for billing issues or discharges should be by email to billing@avantpsychiatry.com

14.2 New Patient Coordinator (Skyler)

  1. Monitor referrals, answer new patient calls, follow-up with new patients prior to first appointment to provide any additional information and/or answer questions, assist in marketing efforts.

14.3 Team Leads

  1. Assist with patient issues who will escalate to upper management as needed
  2. Review schedules and monitor daily clinic operations
  3. Order office supplies
  4. Manage location vendors
  5. Support staff as needed during busy times or during absence
  6. Manage staff productivity and have initial conversation for performance related issues
  7. Discuss non-compliance and issue discharges for patients
  8. Bring staff concerns and possible policy changes to upper management in weekly meeting
  9. Reviewing and maintaining up to date google sheets
  10. Manage staff work and cleaning schedules

14.4 Therapists

  1. Complete notes, get med checks every time unless documented as not needed (superbill sent by therapist in this case)
  2. Call a patient if not in the office or online at time of visit, call again 5-10 mins after, document with a memo, and notify the front desk.
  3. Monitor caseload for non-compliance and notify manager for potential discharges.

14.5 Supervising Therapists

  1. Kyle Johnson, LPC – South Atlanta Interns
  2. Kia Hansford, LPC – Denise and Austell Interns
  3. Denetra Robinson, LCSW – East Cobb Interns

14.6 Prescribers

  1. Document each visit properly
  2. Review labs and check PDMP as needed
  3. Send prescriptions to the pharmacy- confirm pharmacy and e-prescribe
  4. Send superbill utilizing the maximum billing code applicable for visit
  5. Escalate clinical issues to Dr. Justin

Providers and Therapists should escalate patient issues to their in-office manager first. If there are ever concerns with the office manager- please discuss with the Director of Operations.

General Guidance

15.1 Commonly Asked Questions/Resolutions

  1. If a patient can’t pay for a visit? Either reschedule the appointment or we ask the patient to fill out a promissory note stating that they will pay on the next visit.
    What if the patient has a balance? Let them know they have a balance in order for us to see them. We need to collect the balance, staff can make payment arrangements and complete financial assistance forms.

15.2 Gender Issues

  1. If a patient appears as another gender or someone is unsure of gender, use a driver's license as reference and refrain from using pronouns. Pronouns or alternate names should be noted in the patient chart.