2.5 CE Credit Hour (3hr) On Demand, Self Study on Insurance Billing
The Shadow Side of Therapy: Audits, Insurance Coverage, Documentation, and Medical
Necessity
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.
Plus: a helpful handout!
2.5 legal ethical CE credit hours
On-Demand Self Study
You may love working with your clients, but hate dealing with the daily burden of notes,
insurance billing, and audit fears
 This 3-hour webinar will help you bring down your avoidance and
anxiety, giving you confidence in your documentation and billing.Â
We will calmly address your most frequently asked questions, including:
- Notes
- What do insurance plans require in my notes?
- How do I document a client’s need for treatment (Medical Necessity), and why does this
matter? - Should notes be detailed, or vague to protect client privacy?
- Do my notes for telehealth sessions need to be different?
- Treatment Plans
- What should be in a treatment plan?
- What is the biggest mistake therapists make when writing treatment plans?
- Audits
- Why might my records be requested? How should I respond, and what can I do now to
reduce my audit risk? - Can my treatment and notes be reviewed even if I am not in network with an insurance
plan? (the answer may surprise you) - Could an insurance plan really ask for money back if my notes aren’t good?
- Why might my records be requested? How should I respond, and what can I do now to
- Telehealth:
- What’s the latest on telehealth billing and coverage?
Who is this event for?
This course is designed for solo practitioners, group practice leaders, and group practice clinical staff members. It is also suitable for practices that consist of 100% in-person, 100% telehealth, or a mixture of in-person and telehealth treatment.
 In-person Practices
 Hybrid Practices
 Teletherapy Only Practices
Plus a helpful handout to help you navigate insurance billing!
I’ve been watching several of your CE programs and, while I’ve always been impressed with your services, I just have to say, your programs are excellently done with production and content and simultaneously warm and accessible. I really appreciate what you do!
Beat procrastination
Identify 3 ways that notes that are vague, illegible, or written long after the session can harm therapists and clients
Documentation Requirements
Identify 5 common health plan documentation requirements and 2 additional items that may be legally required in telehealth session documentation
Medical Necessity Criteria
Define the components of “medical necessity criteria” used by health plans to approve ongoing treatment, and give an example of how to document this
SMART treatment planning
Identify the components of a treatment plan, and define “SMART goals”
Training is Step 2 of the PCT Way.
Course Details
2.5 CE Credit Hour. Self Study
Title: The Shadow Side of Therapy: Audits, Insurance Coverage, Documentation, and Medical Necessity
Authors/Presenters: Barbara Griswold, LMFT
CE Length: 2.5 CE credit hours, legal-ethical
Legal-Ethical CE Hours: 2.5 legal-ethical CE hourÂ
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”
Syllabus:Â
- 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
Note: Yes! Medical necessity will be addressed in this presentation.
Register
The Shadow Side of Therapy: Audits, Insurance Coverage, Documentation, and Medical
Necessity
On demand self study
Meet Our Presenters
Presented by
Barbara Griswold, LMFT
Barbara 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: navigatingtheinsurancemaze.com.
Resources & Citations
American Medical Association, CPT® 2019 Standard Edition. Chicago, IL; American Medical Association, 2018.
OPTUM 360 (2018). Â 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 http://www.apapracticecentral.org/update/2016/11-17/telemedicine-code.aspx
OPTUM by United Behavioral Health. (2014, February), Coverage Determination Guidelines, Extended Outpatient Sessions, Retrieved March 20, 2018, from https://providerexpress.com/trans/html/pdf/extendedOutpatientVisits.pdf
Dustman, R. (2016, February 16). Prolonged Services Update and Other 2016 E/M Changes. Retrieved March 20, 2018, from https://www.aapc.com/blog/33732-prolonged-services-updates-and-other-2016-3m-changes/
Specific criteria must be met to use prolonged services code.  American Academy of Pediatrics News (January 10, 2018); Retrieved Feb 10, 2019 from http://www.aappublications.org/news/2018/01/10/Coding010518
American Academy of Child and Adolescent Psychiatry. (2018)  CPT Training Manual. Retrieved Feb 11, 2019 at https://www.aacap.org/App_Themes/AACAP/docs/clinical_practice_center/business_of_practice/cpt/2018_CPT_module_revised_March_2018.pdf
Direct Prolonged Serices: Inpatient and Outpatient Coding.  American Academy of Pediatrics (2016). Retrieved Feb 11, 2019 at https://www.aap.org/en-us/Documents/coding_prolonged_services.pdf
The 2013 Psychotherapy Codes: An Overview for Psychologists. (n.d.). Retrieved March 20, 2018, from http://www.apapracticecentral.org/reimbursement/billing/psychotherapy-codes.aspx
NAccuracy, 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 stated.
Commercial Support: None.