Questions & Answers: Audits Therapists aren’t taught clinical documentation in school, leaving them vulnerable to audits and claw backs. The Documentation Wizard is here to help answer some of the most commonly asked questions about audits so you aren’t caught unprepared. QUESTION … [Read more...] about Questions & Answers: Audits
Questions & Answers: Treatment Plans Trying to figure out everything you need to know about clinical documentation can make your head spin! The good news is, I’m here to help! In this month’s blog post I answer some of the most commonly asked questions about treatment plans. QUESTION … [Read more...] about Questions & Answers: Treatment Plans
Medicare just added Prognosis to its list of documentation requirements. UGH! One more thing to think about and document. But how? What Is a Prognosis? Prognosis refers to making an educated guess about the expected outcome of treatment. Based on the medical model, it’s a prediction of a … [Read more...] about How to Document Prognosis for Mental Health
The Insurance Vultures are Circling Insurance companies have recently been conducting audits, like vultures looking for dinner. Especially Medicare. Fight, flight, freeze, or fawn! An audit letter from a health insurance company is enough to send shock waves through your body and make your … [Read more...] about How To Survive A Health Insurance Audit
Is it possible to bill insurance for someone who has Adjustment Disorder for longer than 6 months? Will this be a red flag and trigger an audit? As is typical, when it comes to answers for psychotherapy – maybe and maybe not. To understand the answer to this question, it’s necessary to know … [Read more...] about Can Adjustment Disorder be Billed for Longer Than 6 Months?
Documenting Safety Protocols for Face-to-Face Psychotherapy Sessions Most people agree – change creates upset. Despite the restrictions we experience due to the Covid-19 pandemic, change seems constant. This pandemic will not let us rest in what we already know. Every week or so, there’s … [Read more...] about Documenting Safety Protocols for Face-to-Face Psychotherapy Sessions
Private practice therapists are expected to write a new treatment plan once a year. What happens when your well thought out plan gets thrown to the wind before it's time for an update? This scenario may be happening right now since the sudden outbreak of the Covid-19 pandemic. Problems, goals, and … [Read more...] about How to Document Changes in Treatment During Covid-19 Without Writing Another Plan
Adjusting to Telehealth We’re all trying to adjust to a new way of living and providing mental health services. I’m going to help you navigate the needs for tele-mental health documentation during the Corona virus pandemic. Most insurance companies are now finally on board with offering … [Read more...] about How to Document for Tele-Mental Health During the Covid-19 Pandemic
Do you need to write a discharge summary as a mental health provider? Yes and no. Confusing? Definitely. That’s because the standards are not consistent from one insurance company to the next. Here’s what I can tell you: Discharge Summaries for Medicaid Medicaid requires … [Read more...] about Are Discharge Summaries Mandatory?