Billing Blunders
What happens if someone’s insurance isn’t verified before their first session?
The client or clinic may face unexpected out-of-pocket expenses.
What document ensures the client agrees to treatment and understands their rights?
Informed consent or their signed intake paperwork
Why is it important to collect a credit card on file during the intake process?
To ensure timely payment for services and avoid billing issues.
Where can you start to see the client’s referral network and their own hopes of going to therapy before they come into session?
In their intake documents
What federal law governs the privacy and security of client health information? (*Hint* 5 Letter Acronym)
HIPAA (Health Insurance Portability and Accountability Act).
What is the term for the amount the client must pay out-of-pocket before insurance covers services?
Deductible.
What is one reason why it is critical to review intake paperwork for completeness before the first session?
Missing information can delay treatment AND/OR you can learn a lot about the client’s background
What term refers to the portion of the service fee a client must pay after insurance has contributed?
Co-pay.
What is one mistake we often make when discussing payment responsibilities with clients?
Using overly technical terms without clarification.
not understanding billing yourself
when in doubt--have them email Lisa, if this should disturb the therapeautic relationship. However talking about it from the first intake makes this topic less daunting when it comes time to take payment
What is the consequence of storing intake paperwork in an unsecured location?
Potential data breaches and legal penalties.
Name one consequence of not updating a client's diagnosis and treatment plan?
.
Denied claims or delayed payments.
Your client could benefit from you gaining more information from their school social worker and their doctor. What paperwork would you need and what do you do with it?
Signed ROI – Upload to the client’s file and send in your communication to the provider you are coordinating care with.
What is the consequence of not collecting payment at the time of service?
Increased risk of unpaid balances and little paychecks in return
How long is an adjustment disorder diagnosis ‘good for’ before an update is made for insurance billing/coverage purposes?
6 Months.
Why is it important to confirm a client’s identity during the intake process?
To prevent fraud and ensure correct billing.
*Double jeopardy* (Share screen) Let’s make a new re-occurring client session. This client has a history of trauma that I commonly use additional treatment methods for throughout session that I often document in my note. Today I want to make a re-occurring session for them every Tuesday at 4pm that I never want to end for my convenience. They have Medicaid. Can you walk me through this?
Answer: Must demonstrate (Reoccurring Session) (Interactive Complexity) (Accurate Billing Prices) (Correct Location) (Correct Supervisor).
When creating any client profile for the first time is a client’s emergency contact necessary before intake? Why or Why not?
YES in case of any emergency during the time of the intake or any later session.
Name one reason a client might unknowingly avoid making a payment.
They are unaware of their co-insurance or out-of-pocket costs before starting services; They are unaware of payment plans or were not offered one; They did not know how to log into the portal; Their card was not run before the session was over during the intake.
What should be done if a client refuses to sign the financial agreement?
They should not proceed with services until the issue is resolved.
When completing a treatment plan, what is an intervention?
A modality that you are trained, competent and comfortable to provide treatment in.
Your client wants to contact their insurance provider to ask if we are in network and ask about their responsibility of payment per session before coming in. WOO! What instructions should you give them?
Call your insurance company (number located on the back of your card) and provide our GROUP NPI number to see if we are in network and give them the CPT CODES for INTAKE and COUNSELING SESSIONS. (good faith estimate works too).
Let’s say you have an intake that CATCANCELS on you. (They call the CATS team and cancel). Other than your missed appointment note, what else should you ensure is in their chart?
No Diagnosis Code!
If a client disputes a charge, what documentation is most helpful to resolve the issue?
A signed financial policy agreement/intake.
ROLE PLAY TIME!!
Share our whole intro to a client in their intake session.
this should include:
intro to self/clinical background
expectations of session
insurance/deductible/copay
good fit?
availability/scheduling next sessions
Why is it important to have the correct CPT codes to match the session you are doing?
Insurance fraud, accuracy in payment and billing, ethically correct