Evan Dumas 

You’re listening to Group Practice Tech, a podcast by Person Centered Tech, where we help mental health group practice owners ethically and effectively leverage tech to improve their practices. I’m your co-host, Evan Dumas.

 

Liath Dalton 

And I’m Liath Dalton, and we are Person Centered Tech.

 

Liath Dalton 

This episode is brought to you by Therapy Notes. Therapy Notes is a robust online practice management and electronic health record system to support you in growing your thriving practice. Therapy Notes is a complete practice management system with all the functionality you need to manage client records, meet with clients remotely, create rich documentation, schedule appointments and bill insurance all right at your fingertips. To get two free months of Therapy Notes as a new Therapy Notes user go to therapynotes.com and use promo code PCT.

 

Liath Dalton 

Welcome to Episode 602: Insurance, Documentation, and Audits with Dr Maelisa McCaffrey.

 

Liath Dalton 

Welcome everyone. I am so pleased today to be joined by my friend and colleague the marvelous Maelisa McCaffrey of QA Prep, aka the Documentation Diva. Maelisa has been a longtime collaborator with Person Centered Tech and is our go-to expert for all things documentation and quality assurance as well. Hence the QA and the QA Prep of her businesses title.

 

Liath Dalton 

And we’re talking today because there has been a real uptick that I’ve been observing in anxiety and concern around insurance documentation, specifically with regards to an increase in audits, which then, of course, generates concerns about clawbacks, and then also, all of this kind of occurring in the context of there being sort of changes or even decreases in rates that that folks are seeing.

 

Liath Dalton 

So we invited Maelisa to come talk about these things and to be doing a massively expanded and updated presentation, a CE training, the live event of which will be occurring on January 30, 2026, also recorded and available on demand, on the topic of insurance documentation, how auditors think and why. So welcome Maelisa.

 

Dr. Maelisa McCaffrey 

Thank you. Yeah. I’m excited. I cannot believe when I was looking up the resources from the last time we did this training, because, as Liath said, it is expanded. I think it was from 2015 or 2016 it was, it was so old I didn’t have it in any of my recent information.

 

Liath Dalton 

Right!

 

Dr. Maelisa McCaffrey 

I was like where’s all the stuff from this last training I did? And it was only an hour, and this one will not be only an hour, because I have no idea how I did that training in an hour. There’s no way here.

 

Liath Dalton 

Right, right This will be three hours, and really oriented to the current context of insurance, documentation and audits and so on. Which, that landscape looks really different, now, in 2026, than it did a decade ago, basically. So what are some of those key changes? Or like, the most impactful realities of the current landscape that are impactful for practitioners who are trying to navigate all of this.

 

Dr. Maelisa McCaffrey 

Yeah, so three immediate things come to mind, and we can dig into each one. The first one is obviously AI, whether that is clinicians using AI or insurance companies using AI as part of the audit or review process.

 

Dr. Maelisa McCaffrey 

The second is codes, billing codes. So billing codes had a drastic change in 2013 and because of that, there was some lead in time before insurance companies really started doing reviews based on those new codes and interpreting codes and being more strict about them. So that’s another really big one that has been around for a long time, you know, 13 years now, but has had very different impacts in the last couple years.

 

Liath Dalton 

So that’s when would you say those impacts started to be kind of materialized in the practice landscape?

 

Dr. Maelisa McCaffrey 

I would say it’s, it’s probably been, I think after covid, a lot of shifts happened with covid. Because insurance companies, which was led by Medicare, giving people so much leeway with, you know, not worrying so much about how you’re coding things, because we know, you don’t know how to code it for online. And everyone’s getting online and, and so because of that, there was just, yeah, a lot of leeway given around these nitty gritty things that insurance companies often use as their sticking points. It is very rare.

 

Dr. Maelisa McCaffrey 

This is one, and we can get into that, like insurance is almost never genuinely auditing based on clinical content. It is so much about administrative errors, and so that obviously had a huge impact when they said, we’re not going to worry about that type of thing with covid. So, 2021 they started saying, Okay, we’re, you know, these, these concessions now have to go away. So 2021, 2022, was when they started really digging back in to to this type of thing.

 

Dr. Maelisa McCaffrey 

And I saw a shift in, in how they were presenting that. Also, I would say before that time, it was probably 2018, 2019 when people started getting those letters about 90837, and oh, you’re billing it more than your colleagues, even though everyone was getting the same letter. So how does that make sense? That was the first sign. Then they kind of backed away with covid, and then they really dove head first deep end when they started getting back into things 2022, 20, around that time.

 

Dr. Maelisa McCaffrey 

The other big thing is risk adjustment audits. So I would say, like AI, billing codes, and risk adjustment audits. Those are the three major shifts, and I don’t know which one you want to dig into first,

 

Liath Dalton 

I was going to ask you what,

 

Dr. Maelisa McCaffrey 

Yeah.

 

Liath Dalton 

what your preference was?

 

Dr. Maelisa McCaffrey 

Risk adjustment audits, I think is actually the easiest. And let’s, let’s start with the good news, maybe, right. Okay.

 

Liath Dalton 

Yes.

 

Dr. Maelisa McCaffrey 

So, so risk adjustment audits are part of the Affordable Care Act. I don’t know all the logistics of this, but essentially, when marketplaces started becoming more popular, that’s when you started noticing this pop up more frequently. And so in the last year, especially, I had five times as many questions about risk adjustment audits than I’ve ever had. So I think it is just becoming a more commonplace practice.

 

Dr. Maelisa McCaffrey 

But risk adjustment audits are not the what you think of as a typical audit. They are not about you as a clinician. They are not about you as an individual. They are not about clawbacks. They are not about money in that way. They are not about payment for services. It literally is about reviewing services as an aggregate. So the insurance company has to collect data about all of their members and send that data off to the government. They have, like, different reports they have to do. So that’s, you know, and I’m not, I’m not the risk adjustment audit expert. So if you’re picking out little specific things, that might be a little off there.

 

Dr. Maelisa McCaffrey 

But it has nothing to do with you and clawbacks. And it really has to do with they need to send a report. They do not care about what clinical information they’re getting from that audit. Why they do care about those audits, though, is that that gives them a report that they can submit that shows how quote, unquote well or unwell their collective members are. And unfortunately, funding, at least up until recently, I don’t know how this is all impacted by changes we had in the new bill, but funding is related to how unwell their members are. And so insurance companies were motivated to make their members look unwell. Because if they showed they had a bunch of healthy members, they were actually getting less money than other insurance companies.

 

Dr. Maelisa McCaffrey 

So it’s one of those things where, maybe when people were, created it, it made sense, but on the back end, you can see it’s a horrible idea, right?

 

Liath Dalton 

Right.

 

Dr. Maelisa McCaffrey 

So, because it creates incentive to fudge the numbers a little bit. So they, I think, because of that, and because funding has started to have a lot more have a lot more scrutiny, last year, they were really on top of doing these risk adjustment audits. And if you’re a mental health practitioner, you automatically, now any of those clients who are using their insurance, their insurance company, can say, oh, they’re getting mental health services, that they can automatically include that person to be one of the more unwell people.

 

Liath Dalton 

Mhm.

 

Dr. Maelisa McCaffrey 

And so I think they were very motivated to get information from everyone who was receiving mental health services. But it’s more about them collecting aggregate data than about clawbacks.

 

Dr. Maelisa McCaffrey 

Now, could that potentially mean because they have reached out to you and gotten data that now you will may be a little bit more likely to get another type of audit? Potentially.

 

Liath Dalton 

Right, higher on the radar.

 

Dr. Maelisa McCaffrey 

Right. Now, I haven’t really seen that, but yes, there’s always potential there. But that kind of leads into point number two, if we want to go there, which is the billing codes, so.

 

Liath Dalton 

Yes.

 

Dr. Maelisa McCaffrey 

I always like to remind people insurance companies don’t see your notes. They have no idea what they say, even if you work for a company like Alma, or, you know, work, I guess, you can’t technically work for Alma. If you work with Alma or a, for a company, so we won’t go there. But you know, if you’re doing that, you know, Alma has access to your notes, the insurance company should not, right?

 

Liath Dalton 

Right.

 

Dr. Maelisa McCaffrey 

The insurance company is not looking and frankly, they don’t care. They don’t want to read the details of your notes.

 

Liath Dalton 

Right.

 

Dr. Maelisa McCaffrey 

They get billing data. So think of a superbill you give someone who’s getting reimbursed. That’s the data the insurance company is getting. So they’re getting times, dates, diagnosis codes. Really diagnosis code is the only clinical information they’re really getting, if we want to think about data in that way. So it’s often billing related things that are going to trigger an audit.

 

Liath Dalton 

Mhm.

 

Dr. Maelisa McCaffrey 

I like to say that audits are not random. You, you could actually be randomly selected for an audit, but even when that is the case, and 90% of the time that is not the case, even if that were the case, they’re not dumb. Whether this is Medicare, Medicaid or private and or commercial insurance, they’re all the same in this way. If you’re selected for an audit, they’re not going to waste their time.

 

Liath Dalton 

Right.

 

Dr. Maelisa McCaffrey 

So they look at, they’re going to choose someone where maybe you had a lot of billing errors, or they’re going to choose someone that you’ve been seeing for years. They’re going to look at someone where you have billed more for that person, and where they are likely to find something. But the only thing they have to determine that is billing data. So that’s always what they’re using, as far as their triggers or red flags. And I think it’s helpful to remember that.

 

Liath Dalton 

So in that context, what are the red flags that auditors or that you know, once identified, can be more likely to trigger an audit? I hear a lot of people being like, Oh, if you use this code, you’re going to get audited, that sort of thing. So in a more like objective rather than emotional lens, what are those red flags as you identify them?

 

Dr. Maelisa McCaffrey 

Yes. So I have not yet seen that 90837, in and of itself, is an actual red flag. I have not seen being, people being audited because of that. That being said, that doesn’t mean the case, that can’t be the case this year, next year, etc, and and I do see that as a potential likelihood. However, here’s here’s why I think I haven’t actually seen that, because that’s what you might hear.

 

Liath Dalton 

Yes.

 

Dr. Maelisa McCaffrey 

You know, when people are talking. It’s not simply based on 90837, because if an insurance company were to audit your records, they have nothing to say you should have billed 90834 versus 90837 for a clinical service. There’s no clinical information. As far as I’m, I’m aware there is no such research study that says there is a difference between a 45 minute session and a 53 minute session, right for a given service. So clinically, they have nothing they can point to, to deny or say you should have billed something differently. What they can look at is just numbers, errors.

 

Dr. Maelisa McCaffrey 

You didn’t bill, you didn’t list the amount of time. You didn’t put your start and stop time. So how do we know how long this session happened? You did it inaccurately. Which like, you’re human. You might have billing errors, and a lot of therapists are really bad at admin stuff, so you might make a lot of billing errors, right? So, that happens. And even if you are good, everyone makes mistakes at some point.

 

Liath Dalton 

Mhm.

 

Dr. Maelisa McCaffrey 

So, you know, that’s, that’s an easy thing. So that’s where they could say, oh, there’s a lot of, if they see a lot of errors, that could be a red flag. The other thing is, very obviously, if you bill more than once a week. So if you’re seeing someone more than once a week, really, if you bill 90837, twice a week, obviously you’re charging the insurance company, they’re paying a little bit more. But twice a week, regardless, is always going to be a potential red flag. Doesn’t mean you’re doing anything wrong, but it is a potential red flag.

 

Dr. Maelisa McCaffrey 

And then the other thing. So those are the things that I see in reality, is typically twice a week, or if you have, if this client has had adjustment disorder for more than six months.

 

Liath Dalton 

Mmm.

 

Dr. Maelisa McCaffrey 

So that’s a diagnosis code that is very easy for them to say, oh, it’s been more than six months. That timeframe is in the criteria for the diagnosis, and so it gives them a little bit of wiggle room to say, maybe this, you know, is a therapist who this person doesn’t meet, they don’t meet medical necessity. Which we talk about in the training, right?

 

Liath Dalton 

Yeah.

 

Dr. Maelisa McCaffrey 

But you know, they don’t meet medical necessity, and this therapist is just using adjustment disorder as an excuse so this person can get their insurance to pay for therapy. Which frankly, is something a lot of very good, ethical, wonderful therapists do.

 

Liath Dalton 

Right.

 

Dr. Maelisa McCaffrey 

They use adjustment disorder so someone can get access to therapy with their insurance paying for it.

 

Liath Dalton 

Right.

 

Dr. Maelisa McCaffrey 

But insurance companies are aware of that, and so that means that adjustment disorder, just by itself, is a bit of a red flag, right?

 

Liath Dalton 

And I know that there might also be increased pressures, aside from just the insurance component of things, to be giving an adjustment disorder diagnosis as opposed to something more, like, significant, because I think there, you know, there’s the perception, which I would say is pretty accurate, right, that in terms of different DSM-5 diagnoses, that adjustment disorder is pretty benign in terms of the sort of impact that it is going to have on someone long term, like following them around, whether it be employment, or life insurance, or those sorts of things. And so this is where I know it comes into your trainings and conversations with folks, is making sure that part of the informed consent process is really talking about what the implications of using insurance are, and I know that this is super layered, because there are also the pieces of then, like access to care and just sort of the domino effect and the reality that we are operating in a really broken and dysfunctional system and trying to find the least harmful, most pragmatic path through it, that gets people access to care that’s legal and ethical, that is sustainable for the therapist and that, that is a lot to be balancing. So the adjustment disorder diagnosis, in and of itself, can be a red flag. I’m imagining also if a majority of clients that you’re billing the same payer for have that diagnosis.

 

Dr. Maelisa McCaffrey 

Exactly.

 

Liath Dalton 

Right?

 

Dr. Maelisa McCaffrey 

Yes, and, and it’s one of those things that I’ve literally seen where it it’s not a red flag, or someone hasn’t been audited, but then they’ve been doing it for eight years, and then they are and then the ratifications are pretty negative for the therapist, because they’ve been doing it for so long. And the big thing there is, I’m not saying never use adjustment disorder. I do tell people never use adjustment disorder for more than six months. At that point, simply change the diagnosis to something different. And and literally make that just a blanket rule for yourself 100% of the time.

 

Liath Dalton 

Mhm.

 

Dr. Maelisa McCaffrey 

Regardless of the philosophy around the diagnostics and whether or not you think someone could really qualify. This is where sometimes you have to play the game.

 

Liath Dalton 

Yeah.

 

Dr. Maelisa McCaffrey 

And so I say, you know, there’s, there’s no reason to make it a potential issue, and so only use it short term.

 

Liath Dalton 

Mhm. And then the other red flags are, of course, errors, frequent errors, billing errors. What are the kind of most common errors that you, you see? So people can be like, oh, that’s something I really need to make a mental note of, or kind of incorporate into my operating procedures to double check this particular thing.

 

Dr. Maelisa McCaffrey 

Yeah, really, it’s, it’s often silly things, like you’re behind on your billing, so you’re doing a bunch of billing all at once for multiple weeks, and maybe you accidentally bill the wrong week, or you bill, you know, you’re looking at two people, and bill them both, the billing for these two people under one person, or switch them. You know if you are, if you are billing 90837, but then put a different time.

 

Liath Dalton 

Uh huh.

 

Dr. Maelisa McCaffrey 

And that literally could be because you made an error on the time, or it could be because you made an error and accidentally selected 90837. It could also be because your system is set up so that you plan for everyone to be billed at 90837 and have your times set up that way, but that person was was late, and then now you didn’t actually see them for that full time. But if your electronic health record doesn’t automatically correct that, if the time is different, or if you don’t check up on that. So it could, it could actually be, like a that’s a legitimate billing error. It doesn’t mean you’re being fraudulent, right? You’re not trying to overbill.

 

Liath Dalton 

Right.

 

Dr. Maelisa McCaffrey 

But these things do happen. And I think for me, one of the biggest things you can do is, frankly, hire a biller. So if you’re someone, if you know that you are the type of person who tends to get behind in your billing and have to do a lot of catch up, you’re going to make more errors if you do that kind of thing. And it’s also, if you have a good biller, they should be able to spot some of those errors, like, hey, this time doesn’t match this billing code, we need to fix this.

 

Liath Dalton 

Right, right.

 

Dr. Maelisa McCaffrey 

So I think that’s a lot, a lot of my advice is around, just don’t do your own billing, if you’re not good at it.

 

Liath Dalton 

No, I mean that that makes perfect sense. And I think that’s one of the pieces that comes up frequently in PCT’s work with practitioners and practice leaders is identifying, you know, your strengths and weaknesses. And that when we’re talking about the business operations, and not just the clinical practice, and delegate, like outsource, find the right supportive resources to manage those pieces that are friction filled or are just draining and diminish your capacity and bandwidth to do the things that do require you to be the one doing them, or that are client care focused. And that in the long run and medium term as well, that’s going to bring a lot of benefit to the practice.

 

Liath Dalton 

And I think like getting over that first hurdle of being willing to not be carrying everything yourself and to part with some capital resources in order to make that happen is like it feels immensely challenging, but then I can’t tell you how many times I’ve witnessed this happen and then seen the relief, and then see that translate to greater capacity, that in turn leads to greater revenue, generally. You know, it’s all symbiotic.

 

Dr. Maelisa McCaffrey 

Yeah, it absolutely is. And the last thing around these billing codes is for group practice owners. A lot of group practice owners will tell all of their clinicians to bill 90837, and it really does, if you don’t plan time accordingly, you really put your clinicians in a bind if someone is just a few minutes late, right? If someone is three minutes late, and you’re hoping your clinician does a 53 minute session, automatically, they have almost no time in between clients.

 

Liath Dalton 

Right, that would be two minutes, if you’re lucky,

 

Dr. Maelisa McCaffrey 

Yes. And I see that a lot where clinicians are telling me, or even the group practice owner is telling me, well, I want everyone to bill 90837. But think about the practicality of it. If you’re setting up your entire, because if you want to base how much income you’re bringing in on 90837, it’s some shaky ground. You’re setting things up to potentially be, you know, fudged a little bit by clinicians and difficult to or just difficult to do from a burnout perspective, from a practical standpoint, and then that gets into the last topic, which is AI.

 

Liath Dalton 

Yes.

 

Dr. Maelisa McCaffrey 

Potentially having AI review, this kind of thing.

 

Liath Dalton 

That’s the, like the, I think biggest change in the the landscape has been just this massive proliferation of AI and generative AI that is being used for clinical documentation in a lot of instances. And I’d love your like, elevator pitch for why people are considering AI in their their practice. Like, what’s the solution to, in terms of our hope or aspiration for what it might be providing versus the reality. Which is a slight sidebar. And then, how is AI being used for reviewing clinical documentation, like, how are the insurance companies utilizing it, and how do they view AI generated clinical documentation? I know that’s like five questions in one, but I’ll just let you dive right in,

 

Dr. Maelisa McCaffrey 

Right, yeah, so yes, a lot of people are using AI. A lot of clinicians are using AI for clinical documentation, and it’s becoming more, you know, in the last year, the major electronic health records made it an option embedded within their systems. So I think that has increased a lot of access, along with the fact that it has improved quite a bit. And so, you know, and a lot of people are just more comfortable or more have have resigned themselves to the fact that AI is reality, right?

 

Liath Dalton 

Right.

 

Dr. Maelisa McCaffrey 

So, in our mental health field, it’s, it’s a very different viewpoint than it was two years ago. So so many people are using AI with the intention of saving time and not having to worry about notes, right? Like, thank God if somebody else can do my notes for me. But the reality is, you, you realize reviewing these notes, which is a mandate, yes, just something you absolutely have to do, because they they do make mistakes or or focus on the wrong thing, the non essential topics from the session, that takes time, and it also takes knowledge about what needs to be in a note, right? So you still have to know how to write your notes, and you still have to take the time to review those notes.

 

Dr. Maelisa McCaffrey 

But I think it can be very beneficial if you’re you’re doing it all in a HIPAA, secure way, and that’s a whole other training we have. But if you get all the things, it can be really beneficial. It’s not perfect. Hopefully it’ll get better. I think there’s a lot of potential, especially for group practice owners and clinical supervisors, to use AI to help with review and to identify trends, how that is going to work with personal health information remaining very private, I don’t know, you know. So we’ll see how that’s all going to happen.

 

Dr. Maelisa McCaffrey 

As far as like, if you’re a supervisor looking at a supervisee. And I think it could be really helpful to look at all of their clients and have AI give you some trends among their from among their clients, their full case load and and that could give a clinician really helpful insight, because it’s difficult for us to see that ourselves, and because we work in such a confidential way, right? Something, access to that information that could give us some feedback would be so helpful. So I am hopeful about how that can work. I’m also concerned that the tech companies that are all doing this really do not value privacy. So, so there’s some struggle there, but again, that’s another training, so.

 

Liath Dalton 

Right. Well, and can I just interject there that one thing that you and I have have talked a lot about in that context, and that is a major red flag, and unfortunately, we’re even seeing this with some of the like venture capital owned EHRs, is that they talk about de-identified transcripts, right? Which is just like a complete misnomer. There is no possibility that a transcript is de-identified, right?

 

Dr. Maelisa McCaffrey 

Yes.

 

Liath Dalton 

I digress, though.

 

Dr. Maelisa McCaffrey 

So, so yes, don’t, the takeaway, my takeaway is always the potential for AI to actually improve our clinical work is huge. And like, don’t trust the tech companies.

 

Dr. Maelisa McCaffrey 

Yeah.

 

Dr. Maelisa McCaffrey 

If you want. It boiled down to something.

 

Dr. Maelisa McCaffrey 

So how this, you know, has changed as far as audits go and working with insurance? I have not specifically seen feedback from an insurance company about someone using AI, as far as like, being able to tell whether or not they’re using AI, or even asking questions about, have you gotten consent to use AI? I could see that becoming a thing in the very near future.

 

Dr. Maelisa McCaffrey 

I could also see, as far as reviews happening, so the insurance company doing an audit. They are using AI to audit.

 

Liath Dalton 

Yeah.

 

Dr. Maelisa McCaffrey 

They absolutely are. They are not being upfront about how they are doing that, and in the extent to what to which they’re doing it. So it’s very difficult to determine. But I do know, I’ve had, I’ve worked with clinicians where they said they’re going through an audit, and it was a blatant error on the part of the insurance company, a denial or some kind of review. And when they talked with a representative there, they said, oh well, it was an AI review. So they’re already using AI to deny claim, to deny claims.

 

Liath Dalton 

Oh, yeah.

 

Dr. Maelisa McCaffrey 

I have literally heard from people where that has happened. And unfortunately, it does not appear that AI is quite there yet to be doing that accurately. And that’s concerning. So that is something to be aware of and to know that is a possibility and potentially to ask about, right? If you think that there was a decision made an error, ask, was this a human who made the decision, or was this an AI program that made the decision? And I think you could potentially have different ramifications for for reviewing that based on how they answer.

 

Liath Dalton 

Mhm.

 

Dr. Maelisa McCaffrey 

Hopefully there will be some legislation, some, you know, advocacy around all of these things.

 

Liath Dalton 

Right.

 

Dr. Maelisa McCaffrey 

Because this is not unique to mental health, right?

 

Liath Dalton 

No.

 

Dr. Maelisa McCaffrey 

This is also in all of health care, and I think it’s a concern for all of health care. So I’m hoping that, as we band together, that can be improved. So that is happening. And something to know about.

 

Dr. Maelisa McCaffrey 

The other thing, and I think it’s probably more relevant to mental health clinicians, is, if you do work with one of these, these companies, such as, I don’t know all the names of them, but Alma, Rula, these other, Headway, so these other companies, where you’re sort of using them as this third party to submit billing, to do admin work, when you are using their systems, if you are using their systems, then they all have these AI reviews in place as well. So you’re potentially, and this is something to ask them, right, do, are you having AI review it?

 

Dr. Maelisa McCaffrey 

So, for example, some of them will have pop ups as you submit, as you submit a note. And I might have a pop up, you know, did you include XYZ information? Did you include this, such of a statement, it might give you a pop up about the time, you know? Did you justify using 90837, or something like that? And are those reviews automatic pop ups? Are they pop ups based on the information you submitted, and which means that it’s using something to review what you did submit, right? So you want to know if it has, if their systems have access. Well, they do have access to your client data. But if they have an AI that has access to all your client data. That’s that’s really key, and I do know that they are using it, they are using their AI, their AI platforms, to check for medical necessity.

 

Liath Dalton 

Right.

 

Dr. Maelisa McCaffrey 

And I think when they do their own internal reviews, they are using these AI platforms. And it’s a major, it’s actually a major part of what they’re doing behind the scenes.

 

Liath Dalton 

Right, and how they’re doing it. And this is not specifically related to billing or quality assurance, but a much bigger sort of consideration in terms of principle and ethics and existential threat to the profession, as some might name it, is that they are also, the vast majority of those platforms, are using your clinical data and client sessions and recordings of client sessions to train an AI model in order to have like a AI therapist chat bot.

 

Liath Dalton 

And the majority of those platforms have insurance companies as the majority stakeholder in terms of ownership shares. So just something like wanting to tie it back into the insurance piece, and you might be like, well, why would insurance companies be majority owners or stakeholders in these different platforms and so on? Well, you know, there’s a vested interest if the existence of these platforms makes therapy and mental health care cheaper by first managing it more in a more controlled way, having this QA portion really baked into things, where it’s putting kind of more stringent guard rails on stuff. And then following that, and this, I think, is really the bigger goal, is to have the ability to significantly reduce the number of human therapists that are providing client care and have things move more to an AI model. So just things, things to bear, bear in mind, if you are working with these platforms or evaluating whether they are a fit for for you and your clients to check out.

 

Dr. Maelisa McCaffrey 

And I would say, like, ask questions, right? So ask them, What are if you have in your terms of service that you’re using this to train a model, or that you’re using a specific source? What is that source, right? You are allowed to ask those questions. And so ask, ask them about where they’re getting information and where they are using your clients’ information, how they are using it, where it’s going. You know, you can ask questions indefinitely, and should of them and of any, any technology company that houses your clients’ data. I would say it is still very much wild, wild west with AI, and they are using that to their advantage. It’s not all bad, but do push back and continue to ask questions as these things change.

 

Liath Dalton 

Absolutely. Like being empowered to ask questions, ask the right questions. Continue to be curious, and also don’t always just accept the answer, first answer that you get. Like probe, probe further. Ask for details and specifics and confirmation, because it can very frequently happen that you get the kind of salesy pitch that really glosses over what the, you know, details are, where the details really matter. You know, devil, devil’s in the details, and we see that frequently.

 

Liath Dalton 

So just be, be curious. And I think, you know, a lot of therapists have that innate spidey sense of like, oh, this is, this is intense. This is feels risky, and you don’t always have the ability to put your finger on what exactly feels off. But I want to encourage folks to to listen to that, that gut feeling, and then translate it into particular questions and keep going there. Okay.

 

Dr. Maelisa McCaffrey 

I think kind of my last like, point here would be related to all of this AI and insurance, how they work together, how they’re separate, rely on and really pressure your professional associations to advocate on behalf of both clinicians, mental health professionals and clients, because this is something that our professional associations really should be doing.

 

Liath Dalton 

Mhm.

 

Dr. Maelisa McCaffrey 

They are in DC. You know, they need to be lobbying around this, and they also need to be collaborating. You know, APA, American Psychological Association and AMA American Medical Association and NASW, they all need to be in on this together, because it is all related. You know, all of this AI stuff is inherent to all of healthcare, and all of these insurance things, like these code, the codes and insurance doing automatic denials for things.

 

Liath Dalton 

Mhm.

 

Dr. Maelisa McCaffrey 

You know, hoping that you don’t push back. This is something that all of us in healthcare experience and know is broken, and we really need to push our professional associations to advocate on all of our behalfs.

 

Liath Dalton 

That’s a really great point, and I also appreciate that part of the request of the professional associations is that collaboration with other related professional associations so that there can be, you know, with greater unity and greater numbers and professions represented. Where there is unity, that is going to be more effective at getting, getting heard and getting change enacted. So that’s that’s really important.

 

Liath Dalton 

I’ve seen some, some really great stuff come out of the APA, so far, I’d say, of the different professional associations, they’ve been the ones that have most been kind of directly active around the AI and the insurance pieces from from what I have seen. But hopefully everyone I mean, this isn’t going away. That’s that’s for sure. So I think more and more folks are recognizing that they are impacted stakeholders and have a, you know, the the onus is on them to get involved. So let your let your voice be heard.

 

Liath Dalton 

And for more, like practical application oriented skills, plus, like five different material resources that are oriented to the practical application piece, please join us for Maeisa’s upcoming training, the live presentation of which will be on January 30, and then, as always, it will be available as an on demand CE training.

 

Liath Dalton 

And I would be remiss if I didn’t also tell folks to check out Maelisa’s fantastic book, Stress Free Documentation for Therapists, which is an invaluable resource. So I will put it in the show notes, links to both that upcoming training with Maelisa and to the fantastic book that she has written as a labor of love for all of you.

 

Liath Dalton 

Thank you so much for your time. Maelisa and I can’t wait to see you in a couple weeks for your updated presentation on dealing with insurance, how auditors think and why.

 

Dr. Maelisa McCaffrey 

Thanks so much. I’m looking forward to it too.

 

Liath Dalton 

This has been Group Practice Tech. You can find us at personcenteredtech.com. For more podcast episodes, you can go to personcenteredtech.com/podcast or click podcast on the menu bar.