FAQs - Supervision Guide

How do I communicate with Sherri and her team about billing & insurance issues?

When you have a billing/insurance question, you can contact Sherri in two ways:

You can send her a Simple Practice message if the question or issue needs to include client-specific information.
You can email her if the question is basic and/or doesn't need to include identifying data. This is the preferred method if you have a more general question. Further, if you have multiple questions, try to keep them in one email if possible (for example, instead of emailing her multiple times per day, just include your questions in one email). This makes it easier for her to track issues and respond.

What happens if I need to edit a progress note but I've already signed it?

Send me a message through Simple Practice and I'll unlock it for you to be able to make edits a re-sign.

How quickly do I need to complete client documentation?

You should write and sign all intake/progress notes by the end of the week. Sherri and her team begin to submit claims for the previous week at the start of the following week. It is technically illegal to bill for services when documentation has not been completed

How do i determine a sliding scale rate?

You should use a consistent method for each client to ensure that you're practicing fairly. (A lot of the details below come from Eric Strom)

There are no WA legal requirements that pertain to sliding scales/reduced fees. There are some ethical standards, however. Ethically, sliding scales/reduced fees are fines as long as:

the fee reduction is not discriminatory (i.e., offered on the basis of race, religion, gender, etc.);
we have documented the agreed upon fee in writing;
we provide reasonable notice of any increase in fees;
the fees are fair and appropriate;
we have considered the individual client’s financial circumstances and ability to pay.

Some of you might consider offering one sliding-scale spot and one or two spots that are at a significantly reduced rate (such as $25/session). To do this ethically, you should consider these spots based on the client's financial need (any nothing else, like race, gender, etc. otherwise, it would be discriminatory).

The ethics codes do encourage us to consider offering some sliding scale, reduced fee, or pro-bono services when appropriate. (See AAMFT 8.2; NASW 1.13; AMHCA I.E.2; ACA A.10.c; and ACA C.6.e). In essence, this is a need-based sliding scale.

When you offer a client a need based sliding scale, I generally recommend that you do not collect financial documents from the client (such as pay stubs or tax returns). Just take your client at their word regarding their financial resources and ability to pay. You do not want to be collecting financial information from your clients for a few reasons:

First, the documentation is relatively meaningless since it can be very easy for a client to make fake “proof” of financial need.
Second, financial documents can contain very sensitive information that really should not be added to the client’s medical record.
Third, it is unlikely that you (or I) have the skills or knowledge to fully and adequately assess and evaluate a client’s financial situation.
Lastly, even if the documentation is accurate and we do have the ability to sufficiently evaluate it, evaluating our client’s finances is likely to create a dual relationship that is inconsistent with our clinical role.

Lastly, if you do offer a sliding scale it’s usually a good idea to set a very specific time limit on the reduced rate. For example, you could offer a client a need-based reduced rate of $50 per session for 6 months. At the end of the 6 months, you would reevaluate the client’s need for the sliding scale.

If using a standard sliding-scale, it is recommended that you are consistent in how you identify a rate. Below is the sliding-scale chart that I use as an example: Sliding Scale Fee Schedule

How do I document a fee arrangement with someone who is private pay?

Any time a client is paying out-of-pocket for their sessions (whether it's the full fee or on a sliding scale), you should document this agreement in the session note for which you agreed on the fee.
You will need to have the client complete two more documents:

Self-Pay Agreement: This documents that the client does not have insurance or is opting out of using insurance to pay for services.
Good Faith Estimate: This documents that the client is aware of how much it will cost for them to pay for therapy overall and ensures that there are "no surprises."

Question 5