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Pay bill format for Supervision

hey everyone this is car cross brindle welcome back to the channel I have Ashley back with us again hey Ashley hey so we had another video we wanted to put out uh something else that's on our mind so I was telling Ashley off recording that I've had a couple different consults free consults pop in in the last week and a half and it's a lot of candidates saying hey I heard I could take Medicaid and I was like yes and so somewhere in our community I don't know where this information's coming from I've heard rumors it's from Dora I haven't found it email like that I've heard rumors it's from other supervisors I don't know where it's coming from let's just clear the air as a candidate you can take Medicaid but these folks are coming in saying I want to start my own private practice and I want to serve Medicaid members in my practice and that of course is where this is not going to be what they're hoping for so before we go there what it means to take Medicaid as a candidate let's talk about the different types of supervision because I think that's going to clear this up a little bit so we have clinical supervision for your hours for lure we've got administrative supervision and then we have supervisory billing which is what we're talking about with Medicaid and some insurances so Ashley let's define the first two clinical and administrative supervision first what would you say about those I would say exactly what you said clinical supervision is a supervisor who is fully licensed and has the appropriate Education and Training um that person is providing supervision to someone who is working towards lure and that should be very clear there should be a supervision disclosure statement there should be goals both parties should know exactly what's going on and what is expected as part of that clinical supervision and so for some folks that are doing only clinical supervision but not doing the second part which is Administrative supervision clinical supervisors tend to Define themselves as we're Staffing cases we're looking at counter transference and transference we're looking at self a therapist work like we're doing the meat of what most of us as supervisors love to do which is this clinical component of tell me about your clients and how you're feeling about them and the work that you're doing and so when we think about these three different buckets of how supervisors might show up clinical supervision is the one that most of us love the most yeah I totally agree yeah and it's Dynamic with that being said for people who have who are seeking lure right as candidates they might also have the supervisor do administrative supervision so Ashley and mind what does that look like administrative supervision is more the management piece so how is the business run um how do referrals come in how does billing happen how do team members work together or not if it's a larger agency and the example I like to give is when I worked at a residential facility I had an administrative supervisor who was not a clinician she was the unit manager and so she was several levels above me and I was required to meet with her between weekly and monthly for administrative supervision um so looking at things like policy documentation um not the clinical piece but you know who's on your case load and why and are they going to school and are they you know following the rules on the unit um so less of the clinical component for sure because that wasn't her Lane but that's the example I always use because it's so clear-cut she's not a licensed therapist she doesn't have a master's degree and she's not providing me clinical supervision but she still provides me supervision right and that person could be a licensed therapist in a different setting and so I think that is where some confusion is is there might be a group practice owner who does all the management administrative pieces and who might meet with a pre-licensed supervision but is not providing the clinical supervision or the hours needed for lure right so this is very common like for people in agencies or Comm be mental health who have an administrative supervisor saying write your notes on time are you following all the components we need are you documenting what we ask you to document that kind of like administrative task and then have a clinical supervisor that we hire on the outside like hey I'm not really getting a chance to staff these cases in debth so our community has told us for folks in Community Mental Health it's hard to get the full supervision experience with one hour a week when this person has 12 15 20 clinicians under them so it might look mostly administrative on that and so this person might seek an external secondary supervisor for clinical work especially if they have a specialty you're interested in a population you want to serve some other certification that you're interested in pursuing like a lot of us have now normalized but that's it's pretty normal to have multiple supervisors depending on your circumstance I agree so administrative not the sexy part of supervision definitely important of like documenting your hours how many clients you have on your case load what's your case Lo looking like right now so for folks who are candidates you might have someone who fills the bucket for both who's doing clinical supervision with you in addition to administrative to say I need to know your case load I need to sign off on your notes I need to make sure you're doing timely filing all that kind of stuff um so those two kind of go hand in hand or could be separate now we enter this third category which is where Medicaid and SU insurances some private insurances are allowing this which is supervisory billing how would you define this one Ashley I would Define that as a licensed therapist who is credentialed with insurance is allowed by that insurance company to have a pre-licensed person bill under them so do you want to explain like logistically what that actually means y we're gonna have to yeah because that's I think this is the computer why I've had so many different free consults in the last uh last week and a half really of people saying hey I thought I could take Medicaid and it's like yes and yes you can but not under your own practice right so what Ashley is alluding to is this person who's licensed this licensed counselor Social Work whoever it is who's credentialed with insurance has permission and ATT tests that they are providing a supervisory building to someone underneath them so what that looks like from a hierarchy is they've hired someone under them in their business so when these folks are coming into a consult with me or with Ashley saying Hey I want to take Medicaid in my own practice the problem is you can't take it in your own practice because Medicaid for example candidates don't exist to Medicaid um that's how I've described it not in a rude way but just like they don't know who you are they don't want to work with you until you're licensed Medicaid is old school like that and so even though we have Community MTH Mental Health Centers and group practices that have people taking medicaid It's all under a company or business a that's licensed and is allowed to take Medicaid so for folks listening to this video right now I'm just trying to like say this all different ways to make sure it sticks you can take Medicaid under a licensed person which means you can't through their business through their business yes so there is no workaround I know that people are trying to find someone who's like hey will you take me will you be my supervisory biller so I can take Medicaid my practice no because what happens is this person contracted with Medicaid gets paid by Medicaid their business business gets paid then they pay you for the services you've rendered so in that way you look like either an employee or a contractor under someone else's business to Ash's point so it's not I'm ready to start my own private practice and start the Medicaid as a candidate like that's not an option you have to work for someone else to make that happen yeah um so that's been kind of the disappointment of our community when they've come into these calls being like hey I'm excited walk me through the process and I'm like the process is you have to work for someone else so it's a great practice it's an agency it's a nonprofit it's someone else who's contracted with Medicaid who has a licensed professional at the top of the hierarchy making that possible so I know that's disappointment to our community there's some email out there somewhere that's made this more confusing which is why we felt called to jump on this video to Define that so it's not that you can't work with Medicaid members you also can work with a pro bono if you want to as a candidate but to actually Bill Medicaid it has to come from a licensed provider which in this case is a group practice agency or Community Mental Health Center or nonprofit with someone above you as a candidate that can do that anything else you would add to that Ashley I think adding that you know Insurance views pre-licensed candidates as still learning and growing and needing supervision and so it's not to prevent these people from working or from working with this population it's to ensure that they have the proper education and experience to work with people with clients um and I think after they're licensed then they can choose to credential with Medicaid so it's yes and like you said and it's not right now not that it can never happen we just have to make sure that our pre-licensed people are providing quality services and understand what means to bill Medicaid or Bill insurance or you know work in this field where documentation is a lot more strict than you know your your non-medicaid out outpatient client um and then after two years or three years or however long it takes to get licensed if if you want to go out on your own by all means go out on your own and and do your own work and work for yourself we we love to support people in that Journey yeah we are all about all of you taking medicaid it's lucrative it's helpful it serves the community that needs to be served and so yeah it's just about what's the path to get you to that uh that possibility in this case as a candidate it's coming under somebody else so from these three buckets of clinical supervisor administrative supervisor and supervisory biller this is why it gets messy right it's like you might have someone who's administrative supervision person as well as the supervisory biller because that person is making sure you have notes that are written for the services they billing a supervisory biller person has to attest that they are responsible for anyone underneath them and so that form says I have plans to do this under my Ein group practice or whatever that looks like and at that point their name is on the claim right so this is what still blows my mind in our community and I say this every week of like okay so the rendering person on the claim is the licensed professional contracted with Medicaid yep so at that point they're taking a lot of responsibility for you as a cand not resisting to Medicaid so I just want to like call that out for people and with that in mind you can have a supervisory biller as one individual that you're working with you can have an administrative person if you have a whole hierarchy in a grou practice or agency or whatnot you might have a clinical supervisor within the company or outside of the company Y where this all gets more sticky though is if you're a contractor so let's just like let's just like mic drop the last piece here which is in the state of Colorado from a labor law perspective this is a conversation I a lot as well from a labor law perspective you cannot receive supervision as a contractor from the person who is Contracting you to do the work I'll let that sink in for our viewers for a second you cannot receive supervision for the service you're rendering as a contractor is this happening still in our community yes because every week there's someone who's like I didn't know that because Dora and mental health Practice Act and labor laws of color are not speaking to each other so these are each three different entities they're telling us how to do what we do so contract think of a plumber you contract a plumber to fix the sink they invoice you for the service that they know how to render on their own without your supervision you pay them for what they did same thing applies here in mental health at this point with Contracting in state of Colorado so this is why you could have a clinical supervisor helping you get hours in one as one person you could have a supervisor biller as another person you could have an administrative person within the company itself and it gets a little confusing which is why we want to talk about it y does so if you have someone in your life who is a contractor receiving regular supervision from the company they work for as a contractor that's a no no so they need to contract out for a different supervisor which is why all three of these different labels are possible um all that to say anyone who's listening to this that's a candidate who wants to take Medicaid which is a population we love Ashley and I both love and want to support you with your one route as a candidate right now is to contract under someone else's business who's licensed with Medicaid allow them to build a service with them as the rendering provider attesting they supervising you which means they're looking at your notes signing off on everything and that's how you can serve those Medicaid members in this moment until you're licensed so that is the main takeaway from this video although we have to find three other buckets of like how this looks um I think we wanted to make a video to just hopefully in some ways simplify this even though it's not simple um just put a name to he the ways this works in Colorado with labor law versus Medicaid versus Dora Dora dictates regular supervision for lure hours administrative supervision is more of like cover your cover your ass make sure you're doing your paperwork um that you're filing things on time writing notes that are compliant and then supervisory billing is hey I'm letting you render a service and I'm taking the brunt of that risk and so I'm yeah yeah and they say regular supervision whatever that's defin us right so this is super complicated but hopefully this is like taken away some of the confusion maybe you have more questions from this which is natural but for folks who've jumped into calls recently saying I'd love to take Medicaid into my practice or see clients who have United or Etna or any of the others that allow supervisory billing you're still not allowed to do that as an unlicensed candidate you have to work under someone else's business that's licensed and contracted with that insurance to do so final thoughts Ashley on this idea I think my final thought is in directly related to this but if you do have a clinical supervisor um make sure that you have a written agreement about ours being signed and that it is for clinical supervision and that those hours can be signed towards lure because I think like you said with all this confusion there's people who think they're receiving clinical supervision but they're not and so that's also something I want to caution people to really think about and make sure they have what's in place needed to get that license and that it's actually in place yeah so for folks who are working in Community Mental Health it's more likely that you have people within the agency that are filling all three roles yeah but if you have a grou practice if you're part of something different some other structural organizational difference yeah having something in writing at this is the role this person plays in my professional development the role this person plays in my professional development uh can be really eye openening but also like protects you you're like amag getting clinical supervision for hour am I getting hours required to get paid at this organization and am I getting supervision of my clients I'm rendering under a provider who's licensed so those are those three buckets and how that might look so I love that idea of like yep needs to be in writing how do I make this clear how to make it clear for myself as the clinician getting all the support in all these different ways if that is part of your uh next steps to get licensed to and still serve this population so hopefully this clears the air a little bit I'm sure there are still more questions ashleen are happy to be a resource for you there are plenty of good practices offering supervisory billing who have their nuts and bolts set up the way it needs to be absolutely so that's probably the the SL the aray of Hope for those of you watching who are like I'm a candidate and I really want to serve any of these populations um know that there are options for you there are people who are hiring candidates for this very reason to help you serve the population you want and they have attested that they are supervisory billers for that purpose so seek them out ask us questions if you want referrals of those agencies let me know or those group practices um but this video was really meant to just say hey here's the confusion here are the definitions and go from there so hopefully you can continue to still serve a population you love under the framework that we've identified today Ashley thank you as always for your thoughts your wisdom on this topic I appreciate you all right viewers stay tuned we'll see you next time