Reimbursement, Record Keeping, and Best Practices
Each agency or counseling practice has its own policies and practices for setting client service fees. Some agencies might offer a sliding scale to clients depending upon the clients’ income, while other agencies have a standard fee for services. Agencies and private practice therapists may also have differences in what they can offer to clients in terms of ability to bill outside parties (such as insurance companies, Medicare, or Victim-Witness) for reimbursement of services. Therapists in private practice may accept some forms of insurance for their clients but might not accept all forms of insurance or might not be a Medicare provider.
For this assignment, you will draw from the information you collected during Unit 2 to complete the following:
Part 1: Agency Fees and Billing Practices
· Describe the practices used at your fieldwork site for collecting fees in payment for services provided to clients.
o Do clients’ payments cover 100 percent of the session costs for every session, or does the agency also bill outside parties for clients’ counseling sessions (also called third-party reimbursement)?
o If your site bills for some reimbursement of fees, do they bill a wide range of insurance companies or third-party providers? List some of the companies that your site bills and explain if certain types of third-party payers are excluded.
o What process is used for billing? For example, does the third party pay your site directly or are clients expected to pay out of pocket and be reimbursed by the third party? Does your site have a person designated to do their billing or are the staff expected to manage these processes?
· Evaluate the impact of third-party reimbursement on the practices of a clinical mental health site. Are there any limitations that third-party reimbursement places on a site’s practices or any restriction to the services offered? How would a site’s policy regarding billing third parties for reimbursement either enhance or reduce available services to clients? For example, might some clients not be offered services by the agency?
Part 2: Agency Policies and Record-Keeping Practices
· Describe how clients at your agency are informed about key agency policies such as fees, third-party payment processes, confidentiality, and billing for missed sessions.
o Is a separate intake process used to inform clients about agency practices or is it the assigned counselor’s responsibility to provide this information? Do clients review or sign any forms regarding these agency policies?
· Describe the specific record-keeping practices used at your fieldwork site.
o How does your site maintain client confidentiality and privacy for client records?
· Evaluate the manner in which your site handles client billing and record keeping and the extent to which it aligns with laws, regulations, and ethical standards.
o Which ethical and legal standards are relevant to your setting? Refer to the specific ethical codes and state laws or regulations that pertain to the practices used at your site.
o What does your site do well in terms of their record-keeping practices? Where could it improve?
If your site does not participate in third-party reimbursement, please discuss how it is handled at an agency or organization in your community. You may want to ask your site supervisor to connect you with someone at a local agency whom you can interview briefly about their policies and practices. In your assignment, identify the agency and the position of the person you interviewed there.
Your assignment should be 4–5 pages in length, with a minimum of two references from current articles in the professional literature in counseling. Be sure to cite your references in APA format.