Insurance Documentation for Therapists: How Auditors Think

As access to insurance increases, the hope is that access to psychotherapy will also increase, whether provided in or out of network. However, mental health professionals receive little to no training in how insurance standards or requirements impact their care for people. This is especially true for clinical documentation and approval of services by insurance companies. 

Insurance companies value the concept of “medical necessity” and it is crucial for both in-network and out-of-network clinicians to understand this concept. Documentation is the means by which clinicians justify medical necessity. Ethical and meaningful documentation can serve as a valuable tool when interacting with insurance companies during an audit or advocating approval of mental health services.

Along with feelings of apprehension, there are many myths that clinicians commonly believe about insurance audits and clinical documentation. Insurance companies have specific requirements for documentation, but these requirements are actually easy to understand and can be mastered by mental health professionals. This web conference will provide the “behind the scenes” reasoning for most insurance documentation standards, as well as practical strategies for simplifying the process of writing notes and treatment plans that satisfy these standards.  

In this 2-hour continuing education web conference, Maelisa Hall, PsyD will explain what she has learned in her experience reviewing clinical charts objectively as an auditor. Dr. Hall will discuss what is commonly missed or misunderstood by mental health professionals in their documentation. In this interactive workshop, clinicians can learn how to correct these actions and gain the confidence they need to provide quality mental health care with less stress in their administrative tasks.

This introductory instructional level web conference is designed to help clinicians:

1. Recognize how clinical documentation can assist or deter people from receiving reimbursement from insurance for mental health services.
2. Apply the concept of medical necessity to documentation throughout treatment.
3. Explain how to use medical necessity with various forms of treatment and different populations.
4. Describe how to advocate for people in their care during an insurance audit.
5. Practice the process of reviewing a progress note based on both professional ethics and insurance standards.

Statement of program's accuracy, utility, and risks: The contents of this program are based primarily on the ethics codes of these professional organizations: AAMFT, ACA, APA, NASW, NBCC. Contents are also guided by commonalities in state law and commonalities in published medical necessity criteria from various insurance companies in the United States. Some interpretation and analysis presented is made by the presenter, in consultation with knowledgeable colleagues and expert consultants. Statements about approval or denial of services are according to presenter’s understanding of medical necessity and clinical documentation standards at the time of the program. The presenter may not know how to apply all principles discussed to every situation or person. This program discusses strategies for complying with ethical responsibilities for documentation and advocacy according to the above listed ethics codes. It may not include information on all applicable state laws. Misapplication of the materials, or errors in the materials, could result in denial of payment, denial of mental health services, or non-compliance with applicable laws or ethics codes.

Declaration of conflicts of interest and commercial support: None.

If you have any questions, please contact us here.

Continuing Education (CE) Information

2 CE contact hours will be provided by GoodTherapy for attending this web conference in its entirety.

GoodTherapy is an Approved Education Provider by NAADAC, The Association for Addiction Professionals (provider #135463). Of the eight counselor skill groups ascribed to by NAADAC, this course is classified within Counseling Services. 

GoodTherapy is an NBCC-Approved Continuing Education Provider (ACEPTM) and may offer NBCC-approved clock hours for events that meet NBCC requirements.

GoodTherapy.org, provider #1352, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. GoodTherapy.org maintains responsibility for this course. ACE provider approval period: 3/30/2022 – 3/30/2025. Social workers completing this course receive 2 continuing education credits. 

GoodTherapy is approved by the American Psychological Association to sponsor continuing education for psychologists. GoodTherapy maintains responsibility for this program and its content. GoodTherapy.org received APA approval in May 2011. Events after 2011 may meet APA requirements for Continuing Education credits.

GoodTherapy.org, LLC is recognized by the New York State Education Department's State Board for Social Work as an approved provider of continuing education for licensed social workers #SW-0395.

GoodTherapy, LLC is recognized by the New York State Education Department's State Board for Mental Health Practitioners as an approved provider of continuing education for licensed marriage and family therapists #MFT-0022 and for licensed mental health counselors #MHC-0031.

To receive CE credit hours for an archived event, you will need to complete a survey as well as a 12 or 15-question exam, verifying that you listened to or watched the event in its entirety. Archived CE events generally are considered "homestudy" by licensing boards.

Registration Information

Premium and Pro Membership with GoodTherapy includes access to this web conference at no additional cost. Not yet a member? Sign up for a Premium or Pro Membership here.

Mental health professionals who are not members can attend this live web conference for $30.95 or access the homestudy recording for $15.50. Sign up here to purchase this CE course and earn a CE certificate.

If the event is canceled by GoodTherapy, registrants who purchased the event will be notified and the charge for the event will be refunded

If you have any questions or would like information regarding disability accommodations, please contact us.

• Register NowPlease Login to Member's Area
• Not a Member?Click here for information on membership