One of the choices every practitioner in private practice has to make is how to set your fees.

Karlaye from Arizona writes . . .

. . . I set my base fee at $ 125 per hour . . . but the insurance companies that I work for set it at $85-95. If I have a private patient, its fine, but when I have a client that wants to use their insurance, I can only set it at that price. Is that correct?”

And, Jason from Colorado asks . . .

Is it OK to charge my cash-paying clients $85 / hour and charge my insurance- paying clients $100 / hour?  It’s the only way I can see surviving in this economy.”

When setting your fees, you need to be careful.  Health care providers are the most common perpetrators of insurance fraud.  Sometimes such fraud occurs out of greed; however, it is much more likely that you may be engaging in fee-related practices that are illegal and not even know it.

If you have chosen to work with insurance companies, make sure that you are not charging you cash-paying clients a different rate than those who are filing on their insurance. Regardless of your intent, charging different clients different fees for the same service  (based only on whether or not your client pays cash / uses insurance) is not OK.

Look for a future post when I discuss reduced fees and sliding scale fees.

Tags: Fee, Fraud

Everything you do for your client matters.  If and how you choose to diagnose your client matters a lot.  Amanda B. wrote in asking if it is OK to routinely give a diagnosis of Adjustment Disorder to her clients if they do not exhibit symptoms warranting a more serious diagnosis.  (She was trying to help them get reimbursed by their health insurance companies.)

The short answer is “No it’s not.” As tempting as it may be to slap an Adjustment Disorder diagnosis on to every client who is dealing with normal life transitions, it’s not wise and it’s not OK — clinically, ethically, or legally.

"Worried Woman" by HikingArtist.com / Frits Ahlefeldt-Laurvig

The clinical implication is this . . . by intentionally giving your client the wrong diagnosis, in this case a more serious diagnosis than is truly warranted, you pathologize your client.  This is like going to your primary care doctor for a mosquito bite and him diagnosing you with an infection.  Mosquito bites happen just like life happens.  Misdiagnosing does nothing to empower your client.  Nor does it inform her about the real nature of what’s going on or lead her toward useful strategies for managing the transition at hand.

Ethically you’ve failed . . . to provide honest, accurate and useful information to your client if you’ve told her she has something different than what is true.  You’ve also set yourself up to provide inaccurate information to others i.e. physicians, lawyers, etch.  that may gain access to your records later on.

And, legally, you’re setting yourself up for big trouble. When you choose to list an inaccurate diagnosis on health insurance claims forms and submit them, you have just committed insurance fraud.  Should you choose to put the inaccurate diagnosis into your clinical record, you have falsified documents and failed to meet the professional standard of care.

If knowing all of this you are still tempted (perhaps you believe with good intentions) to misdiagnose a client, seek clinical, ethical, and legal consultation.

[Update 10 Dec. 2009 5:54 pm - Of course, mental health professionals are not the only one fudging on diagnoses.  Check out The Last Psychiatrist blog post, "How Am I Going To Get Paid If It Isn't Autism?"]

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A Speedy Little Tool for DSM-IV and ICD-9-CM Coding

Tags: Diagnosis, Documentation, Ethics, Fraud, Standard of Care

If you are a psychotherapist who is considering extending credit to your client i.e. allowing them to post-date a check or allowing them to pay you later by accruing a balance, you might want to re-think that decision. Check out this article,  “The Red Flags Rule,” written by attorney Richard S. Leslie, J.D.

Tags: Billing, Fraud

Those who know better don’t always choose to do better.  Check out this press release from the U.S. Department of Justice for a clear reminder of the need for therapists to know what they are doing before they make the choice to file insurance for their clients.

Although I strongly recommend that you consider establishing / transitioning your practice to fee-for-service clientele, it is critical that therapists and other  health care professionals have a basic understanding of working cooperatively with insurance companies and Employee Assistance Programs.

If you have questions about these, drop me a line and let me know.  I’ll do my best to answer them!

Tags: Fraud