Dimension I: Acute Intoxication or Withdrawal
Last used marijuana 1 week ago
Last used alcohol 2 days ago
Smoker
Dimension II: Biomedical Conditions and Complications
Height 5 ‘1
Weight 140
Gestational diabetes
Poor eating habits
Pregnant
Dimension III: Emotional, Behavioral, or Cognitive Conditions
Oriented to time and place
No suicidal or homicidal ideation
Victim of physical abuse
Denies history of mental illness
Not currently taking medication
Dimension IV: Readiness to Change
Seriously intending to change because of the unborn child
Dimension V: Continued Problem Potential
Never incarcerated
Dimension VI: Living Environment
Lives off and on with friends
Parents deceased
No siblings
One child
No job
Eligibility
Pregnant woman
Has a two year old daughter
200% of federal poverty limits
Lives in Kansas, has proof of residency
Has SSN and driver’s license
Referred to a facility and began treatment on 10/23/09
Session Type: Group Session
Date: 10/23/09
Time: 3:00 – 5:00 (1.5 hours)
Session Content:
Group began with checking feelings and giving the group a time to express how their week was going and
how they were feeling. In today’s group, clients will learn about addiction and the disease concept. They
will discuss their own powerlessness over their drinking and using and how it has brought then to
treatment. Jane was quiet during group but did answer question when they were directed to her. She
participated in all of the activities and really appeared to put a lot of thought into her feedback.
Sheila Smith, AAPS
Session Type: Group Session
Date: 10/25/09
Time: 1:00 – 2:00 (2.0 hours)
Session Content:
Group watched the HBO movie, Addictions. The film series talks about treatment and recovery. The
film stated that drug abuse starts early. Addiction is a chronic relapsing brain disease. Addiction
treatment is just the beginning. Long term recovery requires commitment.
Sheila Smith, AAPS 10/25/09
Session Type: Individual Session
Date: 10/25/09
Time: 1:30 (1.5 hours)
Session Content:
Jane arrived on time and reported that she had been clean and sober for the past six days. She reported
that she has been looking for housing. Most of her friends use and she doesn’t want to be around those
triggers. She has also attended a prenatal visit and said the baby is doing well. Jane reports that the
baby’s father is no longer “in the picture” because of assault charges she filed against him. Jane will
continue to look for housing and attending prenatal care. She will work on establishing a social circle of
friends that do not use drugs. Jane had to leave early because of transportation issues.
Sheila Smith, AAPS 10/24/09
Session Type: Group Session
Date: 11/4/09 Time: 9:00 – 10:00 (1 hour)
Session Content:
Jane was not able to make it to group today.
Sheila Smith, AAPS 11/4/09
General Format
1. What is the person’s first and last name?
2. What is the name of the facility?
For Data Integrity
3. Use the Excel Data Integrity Claims Example as a Reference
4. The billing data in the first tab of the spreadsheet contains the paid claims data
5. Compare the paid claims data to the sample chart documentation provided
6. Identify the errors based on the following criteria:
a. Documentation of the service exists for the day paid
b. Documentation supports the service paid
c. Documentation contains start and stop times
d. Documentation contains a dated signature
e. Documentation provides member specific detail
f. Documentation supports units billed
Money Lost Example
7. Use the Excel Data Integrity Claims Example as a Reference
8. The billing data in the second tab labeled “money lost” contains a real life example of claims paid
for a member
9. Review the money lost and what could be done differently
10. What if eligibility wasn’t checked and AAPS was billed but the member had Medicaid? What
potential issues might exist?
Please feel free to use these examples at your locations to help staff.