The Shadow Side of Therapy: Audits, Insurance Coverage, Documentation, and Medical Necessity

2.5 CE Credit Hours. Legal-Ethical. Continuing Education Session Replay

Presented By: Barbara Griswold, LMFT

This 3-hour webinar will help you bring down your avoidance and
anxiety, giving you confidence in your documentation and billing.

Course Description

You may love working with your clients, but hate dealing with the daily burden of notes,
insurance billing, and audit fears.

Join insurance billing expert Barbara Griswold, LMFT, of Navigating the Insurance Maze as she discusses the daily burden of notes,
insurance billing, and audit fears while giving you confidence in your documentation and billing.

Educational Objectives

  • Identify 3 ways that notes that are vague, illegible, or written long after the session can harm therapists and clients
  • Identify 5 common health plan documentation requirements
  • Identify 2 additional items that may be legally required in telehealth session documentation
  • Define the components of “medical necessity criteria” used by health plans to approve ongoing treatment, and give an example of how to document this
  • Identify the components of a treatment plan, and define “SMART goals”


  • Why We Don’t Keep Better Progress Notes — And Why We Should
  • HIPAA: Progress vs. Psychotherapy notes
  • What Should be in Your Intake Notes: 11 Common Health Plan Requirements
  • What Should be in Your Progress Notes: 11 Common Health Plan Requirements
  • Telehealth Documentation: Legal and Ethical Best Practices
  • Understanding and Documenting Medical Necessity
  • Analysis of a Sample Progress Note
  • Why Your Notes Might be Requested-by a Health Plan- And How to Respond
  • Insurance Fraud and Altering Notes
  • Treatment Plans: What Should be in Them, Choosing Appropriate Goals, and Updating Them
  • Audits: Why Your Records Might be Requested, How to Respond, and How to Reduce Your Risk
  • Ethical Insurance Billing For Telehealth — Current Codes and Coverage issues


American Medical Association, CPT® 2019 Standard Edition.  Chicago, IL; American Medical Association, 2018.

OPTUM 360 (2018).  Current Procedural Coding Expert.

APA Office of Health Care Financing.  (2016, November 16).  Psychotherapy coding clarifications, telemedicine code modifier added to CPT manual.  Retrieved March 20, 2018, from

OPTUM by United Behavioral Health. (2014, February), Coverage Determination Guidelines, Extended Outpatient Sessions, Retrieved March 20, 2018, from

Dustman, R. (2016, February 16).  Prolonged Services Update and Other 2016 E/M Changes.  Retrieved March 20, 2018, from

Specific criteria must be met to use prolonged services code.  American Academy of Pediatrics News (January 10, 2018); Retrieved Feb 10, 2019 from

American Academy of Child and Adolescent Psychiatry. (2018)  CPT Training Manual. Retrieved Feb 11, 2019 at

Direct Prolonged Serices: Inpatient and Outpatient Coding.  American Academy of Pediatrics (2016). Retrieved Feb 11, 2019 at

The 2013 Psychotherapy Codes: An Overview for Psychologists. (n.d.). Retrieved March 20, 2018, from

2.5 CE Credit Hours.

Presented/Developed By

Barbara Griswold, LMFTBarbara Griswold is a private practice consultant and the author of Navigating the Insurance Maze: The Therapist’s Complete Guide to Working with Insurance — And Whether You Should, now out in its 8th edition. She is celebrating 30 years in private practice, and has taught over 100 trainings on insurance and documentation, providing consultations to therapists nationwide. Barbara invites you to contact her through her website:

Program Notices

Accuracy, Utility, and Risks Statement: The contents of this program are based primarily on the presenters’ extensive combined experience handling legal, ethical, and usable paperwork needs for mental health organizations. Statements about applicability are according to presenters’ understanding of the state of the art and legal precedents at the time of presentation. This program discusses strategies for complying with applicable ethics codes and laws, for improving clinical documentation, and the informed consent process. It may not include information on all applicable state laws. Misapplication of the materials, or errors in the materials, could result in non-compliance with applicable laws or ethics codes.

Conflicts of Interest: None.

Commercial Support: None noted.

This course is subject to our cancellation/refund policy and complaint policy.

2.5 CE Credit Hours.

2.5 CE Credit Hours. Legal-Ethical. Continuing Education Session Replay


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