Detox & withdrawal management
A detox unit that stopped losing bed-days to its own whiteboard
Sixteen beds, a paper census, and a per-diem claim rebuilt by hand every month. The gap between beds occupied and days billed turned out to be the whole problem.
- Level of care
- Withdrawal management
- Size
- 16 beds
- Payer mix
- Medicaid, commercial
- Focus
- Census and per-diem billing
The situation
The unit ran its census on a whiteboard at the nursing station, with admissions and discharges entered into the EHR later — sometimes the same shift, sometimes the next day. At month end, billing rebuilt bed-day counts from whichever source looked more complete.
Two things followed from that. Days were billed that could not be evidenced if anyone asked, and days were delivered that never got billed at all. The second kind is invisible: nobody discovers the revenue they forgot to claim.
What changed
- Admission, transfer and discharge became events on the recordThe census stopped being a separate document and became a view of what the chart already knew.
- Bed-days were derived, not assembledThe per-diem claim is built from the same events that move a patient between beds.
- Safety rounds moved onto the deviceQ15 checks recorded at the point of care rather than initialled at the end of a shift.
- Authorization draw-down ran against the same eventsDays remaining on a case rate decrement as the stay progresses, visible to utilization review.
Results
Three measures, before and after.
Census count and billed days now come from one source, so there is nothing to reconcile.
Billing stopped rebuilding the census and started reviewing it.
Late and missed checks surface on the shift report rather than after an incident.
This is a composite scenario, modelled on the workflows this product was designed against with a clinic director and a revenue cycle management firm. It is not a named customer engagement, and we will replace it with one when a program is ready to publish under its own name.
The takeaway
The reconciliation was never the problem. Having two records was.
If that describes your program, the fastest way to find out whether this holds is thirty minutes with your own workflows rather than a slide deck.
More case studies
Other levels of care.
Residential treatment
Forty beds, one records request, and three days nobody had
A commercial payer asked for six months of charts on four patients. The program had the care documented and still nearly lost the argument on paperwork.
Partial hospitalization
A PHP program where attendance and billing finally agreed
Group-heavy days, per-diem billing, and three separate records of who was actually in the room. The disagreements between them were costing more than the no-shows.
Intensive outpatient
An IOP program that stopped delivering care outside its authorizations
Sixty clients, two tracks, and an authorization spreadsheet reviewed on Mondays. The sessions delivered on Wednesday after a visit limit ran out were never coming back.
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