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Professional contractor invoice for Supervision

hey everybody this is Karen crosswhite brindle again with another video I have my good friend and colleague Ashley with us hi Ashley we are doing another video all things focus on new grads so a question to ask all of you is have you heard about supervisory billing have you had it broken down if not this video is for you Ashley let's start with the defining of supervisory billing for folks watching this video how would you define it so supervisory billing refers to the process of billing for services provided by a supervisee under the supervision of a licensed mental health therapist so what this can look like is an LPC or an LCSW or an lmft owns a group practice that group practice employs pre-licensed therapists so a social work candidate an lpcc and mftc in Colorado or even interns and those pre-licensed therapists or interns can see clients who want to use their insurance but the service is actually build under the licensed therapist's name and information so in other words the licensed therapist assumes responsibility for those Services provided and bills for those services on behalf of the supervisee yeah and so for those of you who are like having a mind moment right now I just want to validate that because when I first learned what this looked like I was like wait a minute so what what Ashley is describing as like the pre-licensed or candidate or person hired by the group practice who's not yet licensed themselves does not exist to the insurance in this capacity like they are behind the scenes they're providing a quality service to the client but they have no liability when it comes to their documentation in the sense of what's billed right so the service the claim is in the licensed person's name obviously the person who provided the services writing a note because you were the one rendering the service but for anyone like me who's like this doesn't track in like a fullest ethical possibility I'm with you like this feels a little funky which is why I actually wanted to create this video to demystify some of the things around supervisory billing and the pros the cons the risks so that you can make an informed choice if this is a position you want to go into as a new grad so that's the definition of it what's the next piece that people need to be thinking about Ashley so I think just to back up a little over the last couple years and maybe you can speak to this too but anecdotally we've seen a huge increase in these types of practices so perhaps a private practice owner has a wait list or a demand for their specialty and that private practice owner brings in someone else to join their group and uses supervisory billing a lot of small groups and mid-size groups that I know of operate based on this model what are you seeing yeah definitely I think it's it's become more of a shift I think probably post pandemic and free pandemics we saw a shift from contractors to employee models here in Colorado and the pandemic makes sense a lot more like control and oversight of the quality of care and so supervisory building might fit under that with a licensed person taking on that responsibility um but yeah I think it also just addresses the Mental Health crisis and the demand so like no judgment for folks who want to do this I think it's just about making sure the people coming in and know exactly what this means and what it looks like just what we're talking about it yeah so summaries supervisory billing is typically used in situations where the supervisee is not yet licensed and is still working towards licensure insurance companies have this process in place or ask that you submit your own documentation of your supervisory process for approval or they ask an attestation form that you are providing supervision to the supervisee who is providing services to the clients the criteria for supervision can vary by setting vary by payer Source or insurance company it can vary by state even so just some general issues to think about too yeah so I think for folks that are taking us on or considering this a big piece of that is in my experience the two qualifiers are quality supervision and regular supervision and then most payers aren't dictating what that actually looks like so they're either defaulting to our licensing board makes sense because that's who's actually like overseeing us in that way or they're just saying go with what is already being done in the community so however you Define quality supervision and however you define regular supervision might also vary her group practice that you're talking to about this opportunity would you agree Ashley I would agree I think one of the pieces that I've seen is pretty common throughout is a supervisor has to sign off on notes or documentation in order for insurance to reimburse the agency for the service being provided and so who's the supervisor one who's the supervisor signing off on documentation to and what type of supervision are you getting and is that on-site as part of being employed by this agency or is it off-site in some sort of capacity right it's like contracted out so we're looking at kind of a distinction between clinical supervision supervisory building excuse me and administrative supervision of like who's doing paperwork who's making sure you're compliant and so that is a great question for folks watching this video to ask is like how many people am I reporting to and for what reason are there is a One-Stop shop where I have one supervisor who's doing all those things or is it I have two or three depending on the roles that they have and does that change the expectations of how often I'm doing supervision and along each of those supervision meetings are okay sure simply put asking questions like who am I billing under who does the billing what is the supervision requirement who provides me supervision and who reviews my notes um and along with that you might get different answers from different agencies and so someone who's looking to join a group that does supervisory billing how can you be prepared to ask these types of questions and engage in a conversation about okay what is my actual day-to-day look like in terms of Direct Services with clients but also administrative requirements such as notes and then the supervisory requirement yeah so ask questions about the that's the takeaway from this video is ask all the questions you need to ask to make that informed choice is this a fit for me does this feel like it's incongruence with your values what you're hoping for as a candidate there'll be tourist licensure right like we recognized Ashley and I both recognize as approved clinical supervisors that supervision is a big part of the development of your growth as a professional and so these questions might then lead to some clarity around the quality of supervision and that regularity of supervision that we talked about earlier absolutely any other thoughts or questions for folks watching this video who might be taking on this opportunity one other question I want to hit on and I know it can be uncomfortable but are you as the pre-licensed therapist the one talking to the client about money and about insurance coverage and some practices have a whole billing department or a billing person who does that and it takes away that conversation and the pressure that we have to have with that client this is require that we are the ones that have the conversation with the client and so how are you getting information about what insurance coverage they have what what is their co-pay do you know what a copay is what is their deductible do you know what a deductible is so I think it's important to highlight there's a ton of insurance lingo out there that has a very steep learning curve and so remembering when we take insurance there's all sorts of nuts and bolts to learn and the supervisory piece is just one of them yeah I love how you mentioned this because I just put a Blog out recently about this so I'll make sure to link it below of like its Insurance terms for you and clients to better understand what we're talking about when we want to use our insurance for mental health services so um you are on the same page that way you know I think the other thing to think about is for these pre-licensed folks you know that conversation is one thing but I think also like what questions do you need to be relayed to the supervisory biller what questions can they answer themselves and then it makes me think of our previous video on the disclosure statement of like is the supervisory Builder identified in that disclosure statement because they are one of the supervisors potentially we're saying it could be two or three um so I guess what are your thoughts on that Ashley do you think they should be listed there as well I think so because sometimes clients get an explanation of benefits or an EOB from their insurance company and the service provided and the rendering provider is going to be listed on that and so if you're the pre-licensed therapist your name might not be anywhere on some documentation that the client receives and so being able to have that conversation up front of yes you are seeing me for this service and here's how I work with my agency here's how I work with my supervisor here are things that could come up and how can we have an open dialogue about what billing looks like for you ultimately allows more clients to be seen we are trying to break down barriers in care with a model like this um and we also want our recent grads or interns or pre-licensed folks to be set up for success in this sort of Private Practice or group practice setting right yeah I appreciate you staying like on that explanation of benefits it's gonna have someone else's name and what if the client freaks out and goes that's not my provider and makes a call to their insurance who's then like wait a minute what's happening here so it can lead to all sorts of confusion worst case it looks like insurance fraud which is not something any of us want to have to deal with so you know as we're talking I'm actually thinking about the the purpose of having a standalone document that outlines this practice does supervisory billing this is what it means here's the supervisors that are responsible for that service the supervisor assigned to your rendering provider is X blah blah blah right it's like I could see that being a really transparent document that would help clients understand the process and then give consent to that particular setup um I think that's that's the right to know but maybe that's just me what are your thoughts I think that's a great idea it is the right to know um in our disclosure statement you know clients have the right to make an informed choice and who's doing their billing how much am I being charged and what services are covered those are all things that help clients make informed choices about their care and I think it is a jumping off point for Education too you know a lot of times we go into Medical Offices or dentist offices and we're just given a piece of paper and like okay here's what you owe and a lot of us don't even know what that means and so if we can be someone who can educate our clients at least a little bit um and open the door for them to have more information about how medical or mental health or dental practices do billing then maybe they'll have some more empowerment to ask questions in other settings too and so also recognizing this is a way one for transparency but two to practice skills we're trying to help these clients build build and have them transfer those into other settings so that they can be their best Advocate love that yeah so it's helping the clients for anyone who's watching this that's a group practice owner maybe to take away for you is that you're creating a document separate or more distinct from the disclosure statement or if this is how we do things here in this practice what questions does the client have and then for folks that are considering a position like this as Ashley already named this is a way of meeting the needs so we're absolutely in support of it I think we can both speak to we just want to be done with a lot of transparency very clear a lot of things in writing preferably and the good news is the colleagues that we know are doing that right they have those attestation documents they have the policy and procedures in place so um please don't be scared off by this video in that way we just want you to know all the working pieces of it any final thoughts Ashley for this video I think we hit a lot of information um I don't think I have any more final thoughts what about you sounds good I would say anyone who's watching this video you know let us know your thoughts in the comments below because obviously this is still kind of a gray area Colorado is currently navigating it other states might be navigating it differently so if you have thoughts for us on this we'd be happy to hear from you in the comments below this video otherwise we'll see you next time