Ethical, Legal and Best Practice Guidelines for Creating and Implementing a Financial Policy/Contract for Your Private Practice
Written by Leslie S. Tsukroff, MSW, LCSW
Founder and Executive Director of Leslie S. Tsukroff, Inc.
Did you know it’s best practice for mental health practitioners to inform clients about the costs of treatment and to educate them about using their insurance benefits and related reimbursement issues? In order to meet informed consent standards around the financial aspects of engaging in services, the NASW Code of Ethics emphasizes social workers’ obligations to provide clients with a thorough explanation of the rights and responsibilities of all parties as well as the risks, benefits and limitations of all things financial.
“Social workers should use clear and understandable language to
inform clients of … the limits to services because of the requirements of a third-party
payer, relevant costs, reasonable alternatives,….” (NASW, COE, 1.03 Informed Consent)
I often hear the following from private practitioners: “Clients should know their benefits;” “I don’t take insurance;” “It’s not my responsibility;” or “I’m private pay only”. Unfortunately, whether in-network, out-of-network or private pay, all clinicians must adhere to this standard. But how?
The NASW Standards for Clinical Social Work in Social Work Practice advises all social workers, including private practitioners, to develop and implement written office policies, procedures and client agreements concerning fees and payment.
“… clinical social workers in private or independent practice shall develop and implement written policies that describe their office procedures, such as the client rights,… fee
agreements; procedures for payment; cancellation policy…” “These policies shall be
made available to and reviewed with each client at the beginning of
treatment.” (Standard 7)
Therefore, all private practitioners should create a financial contract between the client and themselves addressing financial arrangements as well as issues including but not limited to:
· The fees associated with all services including the client’s actual or estimated cost for
all services, 3rd party reimbursement concerns, and services often not reimbursed by
insurance companies
· Identification of the party responsible for verifying insurance coverage, billing and
reimbursement
· Consequences for non-payment (including invoicing errors, clawbacks and denials) by
any/all parties
· Acceptable payment methods, when payment is expected, the party or parties
responsible for payment and information regarding the dissemination of invoices and
receipts
· Terms and consequences regarding cancellations, including appointments not attended
due to emergencies, no-shows, vacations and illnesses.
In addition to these customary matters, mental health practitioners are advised to consult their state’s professional licensing regulations to determine what additional information or other disclosures are required. For example, in New Jersey, if requested, social workers must be able to provide clients and prospective clients a list of professional fees and they are obligated to disclose how those fees have been determined.
For an extensive outline of recommended criteria to help develop a solid financial policy and agreement, contact Leslie to purchase her exclusive Guidelines for Writing a Financial Policy/Agreement. Don’t feel like writing your own? You can purchase one (or all) of Leslie’s Fee Agreement templates to get you started.
Words of Caution
Because it is misleading to prospective clients, I strongly advise clinicians to refrain from stating “most insurance plans reimburse for some or all mental health services”. In the ever-evolving insurance landscape, fewer and fewer insurance plans are not providing coverage for marriage/couples counseling, audio-only telehealth services or audio-visual telehealth services.
Contrary to popular belief, even though the Good Faith Estimate (GFE) outlines estimated costs associated with anticipated services, it is not a substitute for a financial policy and agreement. Under the No Surprises Act, a Federal Law which went into effect January 1, 2022, health care providers, health care facilities and those providing outpatient psychotherapy, must provide a Good Faith Estimate to all clients who are self-pay and do not plan to seek reimbursement from their insurance company for services, as well as those who are uninsured, and therefore, are unable to submit a claim for reimbursement. Read more about this law @ https://www.cms.gov/nosurprises
Practice Management Systems (PMS) and Electronic Health Records (EHR) are fabulous tools to help clinicians streamline their administrative, organizational, financial, and clinical responsibilities. While some of the included practice-related documents are suitable and only require slight modifications, I have found the various informed consent documents to be less than adequate. Why? Because these documents must be customized to each clinician, their particular practice policies, as well as to their respective professional discipline’s ethics and their state’s licensing regulations. For example, some states are prohibited from charging interest on an overdue account, while others place a cap on what may be charged.
In order to protect your practice to the fullest extent possible, to I strongly recommend all practitioners develop a separate, clear and concise fee policy and agreement that meets all ethical, legal and best practice standards. Don’t hesitate to contact Leslie if you would like assistance in drafting a rock-solid financial policy @ Ltsukrofflcsw@hushmail.com
This document is for general informational purposes only and is not intended to be used as advice (legal, ethical or technical) or as a substitute for the guidance of an attorney or an individualized consultation. It does not address all possible clinical, legal and ethical issues that may arise, nor does it take into consideration the particular circumstances, nuances or concerns of the situation or person(s) involved. Leslie S. Tsukroff, Inc. does not assume any responsibility or liability for any errors or omissions in its content.
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