Top 5 Paperwork Resources for Therapists

TOP 5

You became a therapist because you love helping people, not because you love paperwork!

Likewise, I got into quality improvement because I love helping therapists make their paperwork more manageable. Through my years of teaching therapists I’ve acquired a list of places I commonly go for answers, ideas, and inspiration. I’ve compiled five of them that will help you with starting out your practice and getting continued support:

Ethics Codes for Paperwork

While very similar, each discipline has their own ethical requirements for completing and maintaining records. These are basic guidelines for your profession and do not include state laws or HIPAA regulation. I recommend you start here because the principles are easily accessible and brief. Then, seek out laws specific to your state or recommendations from your state’s licensing board or professional association. HIPAA is a whole other deal… I’d encourage you to check out Zur Institute’s online courses specific to HIPAA if you want that information specifically.

Private Practice Paperwork Crash Course

Yes, I’m going to toot my own horn for just a minute. I created a crash course on clinical documentation. In a series of videos sent out over a one week period you’ll learn tips on administrative forms, writing assessments, treatment plans, progress notes and billing to insurance. My goal with this mini course is not to give you forms to copy. Rather, I want to help you gain the mindset and skills to write quality documentation that’s less time-consuming and makes you feel confident for years to come!

The Documentation Sourcebook

This book has a ton of sample forms and a very affordable price tag! It is very detailed but don’t let that scare you. Use the forms as a starting point and pick and choose what you like. They are based mostly on insurance billing so if you have a private pay practice you can overlook a lot of the details.

Private Practice from the Inside Out

Tamara Suttle provides a multitude of practice resources on her website. She has an extensive blog where she frequently highlights experts in specific areas. This includes articles related to client records, HIPAA, insurance and other topics. She’s also super friendly and responds to comments and questions on blog posts with record timing!

Zynnyme’s Insurance Outsourcing Video

If you decide insurance billing is for you then one of the most important things you can do is outsource your billing to an expert. It only takes one problem claim to eat up 10 hours of your time and a large chunk of your profit. Check out this blog interview posted by Kelly and Miranda from Zynnyme where they interview Tiffany, owner of a medical billing company so you can see what it’s all about.

I hope you find these resources helpful. There are lots more out there but I think these are some of the best. What other resources do you use? Leave a comment below so we can continue building our resource lists!

4 Taboo Topics for Therapists

4 Taboo Topics

There are lots of things therapists worry about but rarely discuss with one another. For whatever reason, we are often ashamed to discuss these things, possibly because it may bring up our own insecurities and make us vulnerable to one another.

And the few times I’ve seen therapists bring these things up I often see the “smoke and mirrors” effect where others respond by avoiding the issue or diverting to other topics. Even worse, the therapist that originally brought up the question is sometimes reprimanded or made to feel inferior! Well, I’m going to bring some of these things to light… so that you know plenty of us in the mental health community are thinking about the same things you are.

  • Income- We all know there are “rich” therapists, those who are struggling, and those in between. However, we rarely talk to one another about what is a realistic business plan, how to incorporate insurance into a practice without reducing your income, and how to plan for all the expenses of being in business. Profit and helping people are not mutually exclusive things that we must choose between. Thankfully, this topic is becoming more common in our professional organization meetings and in online forums. I hope this continues so that therapists don’t think they are greedy for wanting a living wage that equals their educational level.
  • Safety- This was always a big one for me when I was doing clinical work. I didn’t work in the safest environment but I was expected to accept this fact and assume the physical risk without question. Unfortunately, this fact was not fully disclosed to me until I was deep in my agency job… and it certainly wasn’t anything a naive, recent graduate was thinking to ask about in an interview! But it’s the truth- some clients pose a risk to us. This doesn’t mean we can’t work with them but it does mean we may need to work with them a little differently. More importantly, it means we need clinical supervisors who are comfortable discussing these topics and who are skilled in strategies that maintain therapist safety while still creating an environment for clinical progress with the client. I’d love to see this topic addressed more at conferences. I know I relentlessly sought training and guidance related to safety and rarely found helpful resources.
  • Feelings for Clients- We have feelings about our clients. All. The. Time. Sometimes our clients annoy us, sometimes they make us feel helpless, sometimes we’re attracted to them. We are human and not immune to the possibilities that human interaction presents. These feelings are not inherently wrong, either, although they often make therapists feel confused or shameful. The important thing about these feelings is to seek consultation. You have a unique but professional relationship with your clients so when something makes you uncomfortable you need someone you can talk to… and I’m not talking about venting to feel better. I mean you need another professional to talk with so they can help you figure out what steps to take and keep you accountable (and, hopefully, remind you that these feelings are totally normally and nothing to be ashamed of).
  • Documentation- Raise your hand if you got awesome training in grad school on how to keep documentation… hm… anybody? I spent four years in grad school and you know how much training I got on this topic… one hour. That’s right- one hour of a single class (that day, not the whole semester) was dedicated to learning how to write notes. No one ever talked about treatment planning… in four years (yeah, let that sink in). Thankfully, I got some training in how to collect intake information during my psychological assessment class (thanks, Dr. Susan Gamble). Documentation is this weird, mysterious thing that no one ever talks about but everyone worries about. Why is it so neglected when it’s so essential to our daily work?

Hopefully, you recognize this is a specialty of mine and I really hope to teach therapists how to do this well and to take away the embarrassment of asking questions about documentation. Trust me- everyone else is wondering the same thing you are! And if you’re still a little embarrassed but dying to get some questions answered, sign up for my free newsletter and crash course (psst… no one but me and you will know you did!).

Did any of these topics hit home for you? Do you have any helpful resources for other therapists to help with some of these taboo questions? Post them in the comments below so we can open up the discussion and help one another out!

3 Insurance Paperwork Reframes for Therapists

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Many therapists are frustrated with insurance coverage of mental health services. They are unhappy with having treatment decisions critiqued, (often but not always) receiving a lower fee than for private pay clients, and needing to submit specific forms for documentation.

These concerns (and many others) are all certainly valid and dissuade some from even dealing with insurance at all. Others begrudgingly choose to bill to insurance because they don’t feel their practice could be full with only private pay clients.

However, many therapists feel insurance is an important part of their practice. Some therapists even view insurance slots as their “sliding scale” slots and account for this in their business planning. I like this way of thinking because it provides the therapist with a positive mindset and reduces resentment toward the insurance company.

So, let’s continue with the positive thinking! Here are some common thoughts that pop up regarding insurance along with positive reframes for thinking about your paperwork and it’s relationship to insurance billing.

“I can’t believe insurance wants to look at my client’s (treatment plan, diagnosis, etc.)! Why won’t they just trust me to do my work?”

–Reframe: I’m so glad my client can receive quality therapy at a low cost to them. I’m glad there’s someone checking to make sure I’m doing my job well.

“Insurance pays such a small fee for my sessions!”

–Reframe: I’m glad I can use this hour to give back to my community by offering a service at my lower rate.

“I have so much paperwork to do for this community clinic!”

–Reframe: I’m thankful that community clinics are able to provide services for much longer timeframes than most insurance companies will compensate for. Unfortunately, that means I have a lot more paperwork to justify their extended treatment.

Notice that I’m not denying the truth in any of the more “negative” statements. Insurance does often pay lower rates than private pay. Insurance does require a certain level of documentation and often scrutinizes that documentation and/or treatment. However, these things are not necessarily bad in and of themselves.

I encourage you to carefully evaluate what thoughts came up for you around billing to insurance. Did you “poo-poo” my positive reframes? If so, I would question whether contracting with insurance is right for you. It’s certainly NOT for every therapist! And you know what? That's okay!

The decision to accept or deny insurance should be part of your business plan and in line with your professional goals. Know that insurance does require a much different level of documentation and oversight than regular private practice. It doesn’t have to be scary or overwhelming… but it will be if you have a negative mindset.

If you’re 100% sure you want to bill to insurance, sign up for my Private Practice Paperwork Crash Course. In a week’s worth of emails I review all the necessary documentation for private practice… and the last lesson is all about billing to insurance.

My goal is to help you make peace with documentation. If you still have any burning questions, leave a comment below and we’ll figure it out together. If you have your own reframes, feel free to post them here and share with your colleagues. Happy writing!

The #1 Reason Therapists Do Paperwork

The #1 REASON

 The best way to have a positive attitude about clinical documentation is to look at the real purpose    behind it. Therapists often hyper focus on certain areas of purpose, such as liability or insurance  reimbursement. However, the real reason we do paperwork is to provide the client’s story.

Every chart tells a story of the client’s work with you. As an objective reader it tells me what you focused  on in treatment, how often you met with the client, and whether or not you followed up with certain  things.

 You spend hours upon hours with your clients doing meaningful work… and it all gets summarized in that little chart in your office (or on your computer).

What happens when you look at the information in that chart? Do you get a sense of the growth that took place? Is it clear how you handled the struggles presented to you? Is it clear that you talked with your client about informed consent and your guidelines regarding confidentiality?

I challenge you to take out 1-2 client charts (bonus points if they’re long-term clients) and look through them cover to cover. Think about things from an outside perspective. Is there anything you read that you find yourself explaining more in your head? Is there anything missing or is it a little too detailed with things you realize don’t relate to treatment (no one needs to know whether or not your client brought their Starbuck’s drink to session)?

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Mostly though, how does reading that chart make you feel? Does it bring out those same feelings that arise if you were to talk about your client? Does it make you feel proud of the progress and things discussed?

My hope is this exercise will help you see what you’re doing well and identify if there’s anything you may need to work on or consult with others about. If that’s the case, feel free to check out my program, Meaningful Documentation Academy.

And if that’s not for you (or even if it is), meet with a colleague so you can share ideas and help one another out. Remember, we are one another’s greatest resource! Happy writing!