Workflow GuideSubstance Use Disorders

SUD Chronic Care Risk Stratification & APCM Workflow Guide

Optimize SUD patient outcomes with AI-powered risk stratification for MAT adherence, 42 CFR Part 2 compliance, and APCM revenue maximization.

Effective risk stratification in SUD care requires balancing 42 CFR Part 2 privacy requirements with high-frequency monitoring of MAT adherence and co-occurring mental health conditions. This workflow leverages AI-driven call handling to categorize patients by relapse risk, ensuring high-acuity individuals receive immediate clinical intervention while automating routine APCM billing.

The Challenge

Manual risk stratification for SUD patients is often reactive, occurring only after a relapse or missed MAT appointment. Practices struggle to maintain the continuous contact needed for APCM billing while managing strict confidentiality mandates and high volumes of co-occurring disorders.

Step-by-Step Workflow

1

42 CFR Part 2 Compliant Intake & Consent

Capture digital consent specifically for SUD records sharing and APCM enrollment via AI-guided phone prompts that explain privacy protections and data handling.

Best Practices
  • Use standardized SAMHSA-compliant consent language
  • Store consent timestamps directly in the EHR
Common Pitfalls
  • Failing to separate SUD records from general medical data
  • Generic HIPAA forms without Part 2 specific language
2

Automated Baseline Biopsychosocial Screening

Deploy AI voice assistants to conduct PHQ-9, GAD-7, and DAST-10 screenings post-detox to establish a clinical baseline for risk and mental health status.

Best Practices
  • Schedule calls 48 hours after initial MAT induction
  • Enable real-time sentiment analysis for distress
Common Pitfalls
  • Relying on paper forms in-office only
  • Ignoring co-occurring mental health symptoms
3

MAT Adherence and Prescription Tracking

Monitor buprenorphine or methadone refill patterns and use AI to detect early signs of pharmacy shopping or missed doses through automated check-ins.

Best Practices
  • Integrate PDMP data with automated call triggers
  • Automate refill reminder calls three days prior
Common Pitfalls
  • Waiting for the next appointment to check adherence
  • Missing early warning signs of diversion
4

Tiered Risk Categorization for APCM

Assign patients to High, Moderate, or Low risk tiers based on screening scores, MAT adherence history, and social determinants of health (SDOH).

Best Practices
  • Align tiers with G0568-G0570 billing codes
  • Update tiers every 30 days based on engagement
Common Pitfalls
  • Static risk assessments that don't evolve
  • Overlooking housing instability as a risk factor
5

AI-Triggered Escalation for High-Risk Events

Configure the AI call system to immediately transfer patients to a clinical coordinator if keywords like 'relapse' or 'withdrawal' are detected.

Best Practices
  • Set up 24/7 crisis routing protocols
  • Use warm transfers to on-call SUD providers
Common Pitfalls
  • Leaving high-risk voicemails in a general inbox
  • Delayed response to urgent patient outreach
6

APCM Engagement and Documentation

Automate the 20+ minutes of monthly clinical staff time required for APCM by using AI to facilitate recovery coaching and check-in calls.

Best Practices
  • Log all call durations automatically for billing
  • Focus calls on specific recovery goal attainment
Common Pitfalls
  • Inadequate documentation for Medicare audits
  • Failing to meet the 20-minute threshold

Expected Outcomes

1

Increased retention in MAT programs

2

Full compliance with 42 CFR Part 2 data handling

3

Maximized APCM revenue via G0568-G0570 codes

4

Reduced emergency department utilization for SUD crises

5

Improved longitudinal PHQ-9 and GAD-7 scores

Frequently Asked Questions

Our AI platform uses encrypted data silos and specific consent triggers to ensure SUD data is only shared with authorized providers, maintaining strict compliance.

Yes, the workflow is designed to document the specific patient engagement and monitoring minutes required for the G0568-G0570 APCM codes.

The system uses Natural Language Processing to detect high-risk keywords and immediately routes the call to a live clinician or crisis line.

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SUD Chronic Care Risk Stratification & APCM Workflow Guide | Tile Health