Insurance Billing and Pitfalls
Advisory Notice: The following advisory is a general discussion of the issues that may arise when a licensee is faced with situations that may be construed as sexual harassment. The discussion is intended to alert practitioners to questions and concerns that they may want to consider with their legal counsel, and is not to be construed as a directive or other requirement to take any particular action. This Advisory cannot be used as the basis for a charge of professional misconduct. The statements are generally based upon statutory and regulatory provisions relating to the practice of psychology, but are not legal interpretations of any of these provisions. The citations to the provisions are included to add clarity to the discussion. Practitioners are advised that if they decide to pursue any course of action based upon this discussion, private counsel should be consulted since there may be legal issues beyond those directly inherent in the practice of psychology that should be considered.
Insurance billing, though seemingly uncomplicated and straightforward, may easily lead to disputes and/or allegations of misconduct. To avoid this, billing statements, insurance claims, and treatment reports should be simple, clear, direct, and accurate representations of the services provided, the fees charged for each service, and the nature of the patient's/client's evaluation and treatment.
- Psychologists would be wise to have the patient's written authorization to release the information necessary to process an insurance claim or to complete a treatment report for pre-certification, although the patient could give a verbal consent. Verbal consents are difficult to prove when charged by a client with releasing confidential information.
- Psychologists should be aware of precisely what they are stating when signing any insurance form or report. They should be aware that what they are asked to state could and does vary dependent upon the insurance form or report. For example, a signature as provider on the insurance form may be a claim that the signatory directly provided the services him or herself.
- When billing for services provided by employees, psychologists should identify the provider by name and title or degree, if it is required on the form. The same is true when insurance forms ask who personally, or directly, provided the service.
- Discussing payment arrangements and insurance issues (including pre-certification) at the first meeting with the patient or client, or soon afterward, could help to avoid any possible misunderstandings and subsequent disputes: for example, co-payments, contract differences, among others.
- Attention to details and making certain that all information is provided when completing insurance forms and reports can help to avoid delays in payment and subsequent misunderstandings and disputes between the psychologist and the patient/client
- When a patient cancels or does not appear for a session, it is usually considered fraudulent to bill an insurance company for that session unless the insurer has provided for cancellations within the contract.