It has come to my attention that there are some billing practices that appear fraudulent. For example, there is an office manager in charge of billing at our office. It is not an electronic note system . . . everything is handwritten, turned in, and then billed to insurance system or Employee Assistance Program (EAP). The number of therapists in our office has grown exponentially, and not all providers have been credentialed and paneled through each insurer. Because of this, it appears as though services are being billed under other credentialed providers. Most recently, it appears as though a psychologist, licensed as an Licensed Professional Counselor (LPC), had a Medicare client that was transferred to me because Medicare will not approve the LPC. Documentary Evidence Documentation can make or break a legal case. According to Barsky (2012), many legal proceedings are increasingly relying on “documentary evidence.” Barsky defines documentary evidence as “any document presented and allowed as evidence in a trial or hearing. Although historically, documents referred solely Group Notes Each client seen in group, family, or conjoint therapy must have their own clinical record. It is not advisable to write one (the same) note for each person and put the identical notes in separate charts. This form of documentation is inaccurate and incomplete because it is not specific enough to the individual client’s treatment. Additionally, clients who are seen in both individual and group sessions should have separate notes about their individual and group participation that in no way reveal the identity of other group members, thus protecting other parties in the group if an individual’s records have to be disclosed (Bodek, 2010). Notes documenting group or family sessions should include the clinician’s observation about the client’s functioning Client Access to Records O’Rourke (2010) views the clinical record as a process for monitoring services that is eventually explained and available to service users. “The very exercise of observation and interpretation of clients’ behavior, and the recording of those observations and interpretation, is an exercise in power . . . the spotlight is on the client, much less so on the practitioner” (O’Rourke, 2010, p. 29). The mental health value of self- determination is reflected legally in freedom of information legislation, meaning that records can inevitably be seen by clients. This legislation serves as a way to balance the power differential between clients and providers. The NASW Code of Ethics (2017a), Standard 1.08, addresses client access to records. It is written based on the value of self- determination. Essentially, clients should have access to records, although records are ultimately the property of the agency or provider. Typically, the physical record is viewed as the property of the clinician, while the information contained within the physical record is viewed as the property of the client. Generally speaking, clients have the right to view and obtain a copy of their records, although there may be some exceptions such as access to records of forensic clients or in child protective services settings (U.S. Department of Health and Human Services [HHS], n.d.). Workers may lean toward paternalism when clients request records, concerned that reading clinical notes might trigger adverse reactions in clients. Ultimately, the client has the right to see the record, yet clinically they may be seeking only feedback and reassurance, which can be provided without reviewing specific documentation. Patient access is a controversial issue. Not without opposition, OpenNotes (n.d.) is a national initiative working to give patients better access to the clinical visit notes written by their doctors, nurses, or other clinicians. Medical clinics and primary care offices increasingly are installing patient portals to allow patients to view their entire medical chart online. Following that trend, some medical centers, as part of an ongoing effort to make care
I am approved as a Licensed Clinical Social Worker (LCSW). I know the LPC has other Medicare clients and I think they are being billed under me. If I address this with the owner and steps to correct billing are taken, what is my obligation to tell the insurance company or clients? Since the private practice owner takes care of credentialing, how culpable am I if that is part of the owner’s responsibility? The LCSW in this situation may indeed have some responsibility and could risk her own approval rating with the insurance company, in addition to a potential sanction by the licensing board. In addition, the agency is not meeting insurance provider requirement, which could lead to possible revocation of payments. to information written down on paper, documentary evidence may also include information stored on cameras, video or audio recorders, smart phone, computers, the Internet, or similar media” (p. 216). Affidavits and reports are the most common documents written by practitioners that are used in court. in the group or family session, observing particularly the individual client’s involvement in the process. Bodek (2010) sums up group documentation succinctly. The progress/session note for each person in the group, conjoint or family therapy, should focus on that individual’s mental status, behavior, participation and functioning in the session, and their reaction and responses to the themes and processes that arose during the sessions. It should avoid to the extent possible, mentioning any identifiable material from or about other particular members of the group, couple, of family, unless this is necessary for clarity. (p. 20) more transparent, have begun posting the mental health notes in patients’ electronic medical records, giving patients immediate access to the summaries at home (Kowalczyk, 2014). Legally and ethically, in general, practitioners are bound to release records to clients. HIPAA stipulates access rights for patients to (U.S. Department of Health & Human Services, Office for Civil Rights, n.d.): ● View records in a timely manner ● Request changes to their records ● Know who else has seen the records There are some caveats to these requirements, such as circumstances when records can be withheld. Withholding or not releasing records in a timely manner or releasing records when not permitted can subject the provider to a licensing complaint, HIPAA complaint, sanctions, or lawsuits. A particularly challenging issue is parental access to records. Often parents feel entitled to know the course and progress of treatment. Practitioners must abide by the laws of the state in which they practice when, for example, needing to obtain a signed release from the child client after a certain age. Balancing the parental demands, clinical desire for parental involvement, and therapeutic alliance with the client poses a risk for ethical breach. The Legal Defense Fund of the National Association of Social Workers states: “It is important that providers have a foundational understanding that parents generally have the right to access the medical and mental health records of their minor children. This is considered a parental right and interfering with this right should only be considered after assessing the child’s emotional condition and relationship to each parent and based on sufficient knowledge of the applicable legal standards for denying parental access to records as well as the appropriate procedures to follow. State health privacy laws
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