Neuropsychology Salary

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WisNeuro said:
To get a very rough estimate, take a look at the MEdicare fee schedule and sketch out what your average eval would be for what you will see most often. For example, dementia eval with feedback, 1 unit 90791, 1 unit 96132, 1-2 unit 96133, 1 unit 96136, 5-6 units 96137, etc. Then you can calculate what medicare would pay based on the RVUS. Multiple that by how many of those evals you'd do in a week, then multiple that by how many weeks you're going to work. Adjust for no shows (my rate is <5% for clinical).
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I thought a dementia eval would be 96116 rather than 90791... do I have that wrong?
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I suspect it could also depend on the insurance and if you're billing on the medical side, mental health side, or both...?

But using Medicare rates, let's say you do all your own testing and your average eval is: 96116 x1, 96136 x1, 96137 x5, 96132 x1, and 96133 x3 (including your 1 unit for feedback). That works out to just over $770 per eval. Take off about $100 if you instead bill 2 units of 96133.

Extrapolated at 5 evals/week for 48 weeks/year, that's $185k. Assuming 100% show and collection rates (which of course won't happen). For 4 evals/week, that's $148k.

If you use a psychometrist and do 1 unit of your own testing + 5 more units of their testing, assuming I set it up correctly, you're looking at about $746 per eval (or again, about $100 less for 1 less unit of 96133). At 5 evals/week, that's $179k.

Private insurance rates will probably be a smidge higher than the above.

So basically, it can be tough to make a decent living without a psychometrist when you consider taxes, expenses, and a handful of no-shows. Particularly if you plan on seeing less than 5 patients/week for assessment. If you do at least 3-4 evals yourself per week and have a psychometrist knocking out 5/week (or have two psychometrists each doing 5 evals/week for $179k a piece annually), that seems more doable. Although that's a lotta reports. And with that many patients coming in, you'd probably want at least one support/administrative staff person (i.e., not just yourself and the psychometrist).

But I could also be way off on those numbers.
 
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AcronymAllergy said:
(or have two psychometrists each doing 5 evals/week for $179k a piece annually), that seems more doable. Although that's a lotta reports. And with that many patients coming in, you'd probably want at least one support/administrative staff person (i.e., not just yourself and the psychometrist).

But I could also be way off on those numbers.
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1) Those numbers look right.

2) Two technicians, doing five per week is not feasible. The schedule doesn't allow leeway for no shows, illness, or "rush" cases. It's also a foolish way to treat technicians. It doesn't give them time for scoring, so they rush, which leads to scoring errors. Or you burn technicians out and get a staffing problem.

At 10 assessments per week, you have 10 hours of interviews, 10 hours of feedback. If you want to keep a 40hr work week, you have to write each report in 2 hours, without fail. That doesn't leave time for anything else (e.g., payroll, going to your CPA, dealing with referral sources who need something "right now", buying supplies, getting sick, etc).

At 8 assessments per week, 16 hrs are dedicated to face to face work. But if you write each report in 2 hrs, you have one day per week to handle everything else.

3) If you're willing to write on nights and weekends, those numbers substantially change.
 
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PsyDr said:
1) Those numbers look right.

2) Two technicians, doing five per week is not feasible. The schedule doesn't allow leeway for no shows, illness, or "rush" cases. It's also a foolish way to treat technicians. It doesn't give them time for scoring, so they rush, which leads to scoring errors. Or you burn technicians out and get a staffing problem.

At 10 assessments per week, you have 10 hours of interviews, 10 hours of feedback. If you want to keep a 40hr work week, you have to write each report in 2 hours, without fail. That doesn't leave time for anything else (e.g., payroll, going to your CPA, dealing with referral sources who need something "right now", buying supplies, getting sick, etc).

At 8 assessments per week, 16 hrs are dedicated to face to face work. But if you write each report in 2 hrs, you have one day per week to handle everything else.

3) If you're willing to write on nights and weekends, those numbers substantially change.
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I definitely wouldn't want to be overseeing 10 evals/week, every week, ad infinitum. But I'm not sure having a technician test 1 patient per day, 5 days a week would be horrible for them, assuming each eval is 3-4 hours of testing time for them. I imagine once they're fully trained and have some experience, they'd be able to handle the scoring for that type of battery in an hour. Maybe I'm missing something, though.

Although yeah, if you're actually planning on 10 evals/week, you should also plan on working >40 hours/week on average. If you have two techs testing 8 patients/week, that may leave them some additional time to help with some administrative tasks. Or you have one technician who works full-time testing and scoring while the other does that part-time and helps with administrative work part-time.

A tech performing 4 evals/week with Medicare numbers would bring in $143k. Not sure what their cost would be in terms of salary + benefts/etc., but I'd hazard a guess of around...$50-60k maybe? So you're left with ~$80-90k for yourself. Which with two techs is about the same as doing 5 evals/week yourself with no techs.

To me, it seems like one tech + doing some of your own testing looks to be the sweet spot. Unless you just hate test administration.

But I also have zero experience running a 100% clinical private practice, so I'm just thinking out loud.
 
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AcronymAllergy said:
I definitely wouldn't want to be overseeing 10 evals/week, every week, ad infinitum. But I'm not sure having a technician test 1 patient per day, 5 days a week would be horrible for them, assuming each eval is 3-4 hours of testing time for them. I imagine once they're fully trained and have some experience, they'd be able to handle the scoring for that type of battery in an hour. Maybe I'm missing something, though.

Although yeah, if you're actually planning on 10 evals/week, you should also plan on working >40 hours/week on average. If you have two techs testing 8 patients/week, that may leave them some additional time to help with some administrative tasks. Or you have one technician who works full-time testing and scoring while the other does that part-time and helps with administrative work part-time.

A tech performing 4 evals/week with Medicare numbers would bring in $143k. Not sure what their cost would be in terms of salary + benefts/etc., but I'd hazard a guess of around...$50-60k maybe? So you're left with ~$80-90k for yourself. Which with two techs is about the same as doing 5 evals/week yourself with no techs.

To me, it seems like one tech + doing some of your own testing looks to be the sweet spot. Unless you just hate test administration.

But I also have zero experience running a 100% clinical private practice, so I'm just thinking out loud.
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Have any NPs had experience training psychometrists to engage in aspects of report writing (e.g., writing up parts of a results section)? I'm thinking specifically about practitioners in states where psychometrists (with master's degrees in clinical psychology) are eligible for mid-level licensure... I imagine that an arrangement like this could also have a major impact on productivity.

In terms of psychometrist feasibility: 3-4h of testing, 1-2h of scoring, 1-2h of writing up results? with one day per week left free for general admin/catch-up? That doesn't seem particularly onerous from my perspective.

Alternatively, maybe the time spent supervising/double checking someone else's results section is negligibly different from writing it oneself?
 
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mxbz said:
Have any NPs had experience training psychometrists to engage in aspects of report writing (e.g., writing up parts of a results section)? I'm thinking specifically about practitioners in states where psychometrists (with master's degrees in clinical psychology) are eligible for mid-level licensure... I imagine that that could also have a major impact on productivity.
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I know folks who do this and it seems to work relatively well for them once the psychometrist has a feel for their report style. At the very least, a psychometrist could relatively easily input scores into a report template, or into an Excel file that auto-populates into the report template.

I'm probably a bit of a control freak in that regard, so I prefer writing my own reports rather than making a psychometrist deal with the stress of my micromanagement. I also tend to conceptualize as I write/dictate.
 
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mxbz said:
Have any NPs had experience training psychometrists to engage in aspects of report writing (e.g., writing up parts of a results section)? I'm thinking specifically about practitioners in states where psychometrists (with master's degrees in clinical psychology) are eligible for mid-level licensure... I imagine that an arrangement like this could also have a major impact on productivity.

In terms of psychometrist feasibility: 3-4h of testing, 1-2h of scoring, 1-2h of writing up results? with one day per week left free for general admin/catch-up? That doesn't seem particularly onerous from my perspective.

Alternatively, maybe the time spent supervising/double checking someone else's results section is negligibly different from writing it oneself?
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Technically, you cannot bill for tech time writing reports. I know some people that do, but according to the billing guidelines that I have seen, I wouldn't want to be audited for that. It would also weirdly inflate your testing time, which would trigger an audit and denials at certain PITA insurers (e.g., BCBS). In your above example, that's 1unit of 96136 and 15 units of 96137. Some insurers get weird when you bill 8-10 of those units, let alone 16.

Also, why would you have techs do the part of the eval that nets you some of the highest RVU figures? It would make some sense if you were cash pay, but it loses usefulness when you deal with medicare/insurance.
 
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WisNeuro said:
Technically, you cannot bill for tech time writing reports. I know some people that do, but according to the billing guidelines that I have seen, I wouldn't want to be audited for that. It would also weirdly inflate your testing time, which would trigger an audit and denials at certain PITA insurers (e.g., BCBS). In your above example, that's 1unit of 96136 and 15 units of 96137. Some insurers get weird when you bill 8-10 of those units, let alone 16.

Also, why would you have techs do the part of the eval that nets you some of the highest RVU figures? It would make some sense if you were cash pay, but it loses usefulness when you deal with medicare/insurance.
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Good point that completely slipped my mind. It certainly makes sense to have the tech handle administration and scoring, but less so with report writing, given the much greater reimbursement rates there.
 
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mxbz said:
Have any NPs had experience training psychometrists to engage in aspects of report writing (e.g., writing up parts of a results section)? I'm thinking specifically about practitioners in states where psychometrists (with master's degrees in clinical psychology) are eligible for mid-level licensure... I imagine that an arrangement like this could also have a major impact on productivity.

In terms of psychometrist feasibility: 3-4h of testing, 1-2h of scoring, 1-2h of writing up results? with one day per week left free for general admin/catch-up? That doesn't seem particularly onerous from my perspective.

Alternatively, maybe the time spent supervising/double checking someone else's results section is negligibly different from writing it oneself?
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1) Big no-no.

a. At the end of the day, your license is responsible for everything in that report. Most legal actions, including board complaints, start with "did you prepare everything yourself?"

b. There are federal and state rules that require you to be on-site during supervision.

2) If you want to be more productive, structure your reports differently. We don't have to write one way, nor did we always write reports this way. Donders has some article about alternative report formats. Historically, you can see how reports were written differently (e.g., HRB books.) If you consult your referral sources, you can learn what they want, and how they want information presented. Alternately, you can learn based upon how medicine writes up normal physical exams or normal lab values.
 
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AcronymAllergy said:
I suspect it could also depend on the insurance and if you're billing on the medical side, mental health side, or both...?

But using Medicare rates, let's say you do all your own testing and your average eval is: 96116 x1, 96136 x1, 96137 x5, 96132 x1, and 96133 x3 (including your 1 unit for feedback). That works out to just over $770 per eval. Take off about $100 if you instead bill 2 units of 96133.

Extrapolated at 5 evals/week for 48 weeks/year, that's $185k. Assuming 100% show and collection rates (which of course won't happen). For 4 evals/week, that's $148k.

If you use a psychometrist and do 1 unit of your own testing + 5 more units of their testing, assuming I set it up correctly, you're looking at about $746 per eval (or again, about $100 less for 1 less unit of 96133). At 5 evals/week, that's $179k.

Private insurance rates will probably be a smidge higher than the above.

So basically, it can be tough to make a decent living without a psychometrist when you consider taxes, expenses, and a handful of no-shows. Particularly if you plan on seeing less than 5 patients/week for assessment. If you do at least 3-4 evals yourself per week and have a psychometrist knocking out 5/week (or have two psychometrists each doing 5 evals/week for $179k a piece annually), that seems more doable. Although that's a lotta reports. And with that many patients coming in, you'd probably want at least one support/administrative staff person (i.e., not just yourself and the psychometrist).

But I could also be way off on those numbers.
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So to highjack this thread, based on these numbers which are similar to what I calculated, does a side gig doing 1 dementia eval a week at $65.00/hourly seem fair? It is a 35/65 split but at the same time seems low for a qualified provider. Anyone have thoughts on this?
 
EPPPb42020 said:
So to highjack this thread, based on these numbers which are similar to what I calculated, does a side gig doing 1 dementia eval a week at $65.00/hourly seem fair? It is a 35/65 split but at the same time seems low for a qualified provider. Anyone have thoughts on this?
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So you'd be a 1099 for someone to do the one eval a week? that 35/65 split seems more than fair. If anything, as a clinic owner, I'd probably only offer someone 55/45 splits if they only wanted to do one eval a week, the administrative overhead/extra work is almost not worth it at that volume. Less than that if I offered psychometrist support.
 
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Thanks for your response! Yes, and I agree after the running the numbers... I think I was just surprised about the hourly break down.
 
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I am newly licensed and have not billed for services yet so was in general surprised by the breakdown of the Medicare reimbursement rates for a doctoral level provider. My understanding is that the rates continue to go down, despite inflation, etc.
 
EPPPb42020 said:
I am newly licensed and have not billed for services yet so was in general surprised by the breakdown of the Medicare reimbursement rates for a doctoral level provider. My understanding is that the rates continue to go down, despite inflation, etc.
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Yeah, they especially gutted the rates for the testing if done by the neuropsychologist. Here it's about $40 per unit of testing time, ~90 for the status exam, 100-130 for the conceptualization/report writing/feedback.
 
EPPPb42020 said:
So to highjack this thread, based on these numbers which are similar to what I calculated, does a side gig doing 1 dementia eval a week at $65.00/hourly seem fair? It is a 35/65 split but at the same time seems low for a qualified provider. Anyone have thoughts on this?
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If you're not having to do anything for yourself, then yep, that sounds reasonable. Although is it a flat $65/hour, or is that just what you've approximated based on Medicare or other insurance rates in your area? You could always see if they're willing to go to 70/30, but with a volume that low, I'm not sure it's worth haggling. Others may think differently, though.
 
Thanks for your earlier post. It was helpful to see that what I calculated for revenue generated was similar, and I agree not worth haggling. It's a side gig and other than clinical service they handle all the billing, overhead etc.
 
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This thread was a little amusing because it deviated quite a bit from thread title, but I always enjoy talking about this one.
15 therapy patients a week? That is hilarious and not out of line with what I have heard and seen from many. Part of why I don’t like to work for an agency that pays everyone the same is that so many people in the field don’t work hard or smart.
 
smalltownpsych said:
This thread was a little amusing because it deviated quite a bit from thread title, but I always enjoy talking about this one.
15 therapy patients a week? That is hilarious and not out of line with what I have heard and seen from many. Part of why I don’t like to work for an agency that pays everyone the same is that so many people in the field don’t work hard or smart.
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I know a Neuropsych who takes insurance. But she has a three hour slot where she goes over the results and bills outside of insurance for that. Is that kosher?
 
Heist said:
I know a Neuropsych who takes insurance. But she has a three hour slot where she goes over the results and bills outside of insurance for that. Is that kosher?
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i don’t take insurance because of issues like that. CMS and their procedure codes and insurance reimbursement have created a system that dictates what we think we can and can’t do so it’s hard to say. I used to not be able to bill for therapy over the phone, but Covid changed that. I remember people saying that you weren’t “allowed“ to see a patient the same day as the psychiatrist saw them because insurance wouldn’t pay for it. A three hour feedback session is not going to be paid for by an insurance company so unless you have a contract with an insurance company that limits you to only do what they will pay for and that you cannot bill patient directly for anything, then I think it is ok.
 
Heist said:
I know a Neuropsych who takes insurance. But she has a three hour slot where she goes over the results and bills outside of insurance for that. Is that kosher?
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Depends on the insurer, without knowing the details, I don't think most situations like this would be kosher for Medicare. The feedback session (going over the results) is wrapped up in the 96132/133 codes.
 
smalltownpsych said:
i don’t take insurance because of issues like that. CMS and their procedure codes and insurance reimbursement have created a system that dictates what we think we can and can’t do so it’s hard to say. I used to not be able to bill for therapy over the phone, but Covid changed that. I remember people saying that you weren’t “allowed“ to see a patient the same day as the psychiatrist saw them because insurance wouldn’t pay for it. A three hour feedback session is not going to be paid for by an insurance company so unless you have a contract with an insurance company that limits you to only do what they will pay for and that you cannot bill patient directly for anything, then I think it is ok.
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She is on the insurance panels. If people don't use their insurance then she does the three hour feedback. If they use their insurance then she does one hour feedback.
 
Heist said:
She is on the insurance panels. If people don't use their insurance then she does the three hour feedback. If they use their insurance then she does one hour feedback.
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Yeah, I suspect different insurance companies have different rules, then. But if someone prefers to pay out of pocket, I suspect it would be ok unless expressly forbidden by the insurance company's contract/agreement. My understanding is that it would generally be a no-go with Medicare, although I also don't know if it would matter that it's not a service Medicare would normally reimburse (e.g., same as if they, say, went for a second opinion evaluation that Medicare may not pay for). But it sounds like in those cases, she'd stick to a one-hour feedback anyway.
 
Heist said:
The patients tell me. She has reviews too where people complain they have to pay for the feedback to get their results.
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Are these kids or adults being tested? For medical, academic, or financial/fiduciary reasons?
 
Heist said:
The patients tell me. She has reviews too where people complain they have to pay for the feedback to get their results.
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I could see why patients would be complaining. Providing feedback is part of an assessment. I also don’t understand a three hour feedback session. My feedback sessions tend to be shorter than an average therapy session as typically following through with the recommendations is what counts and if I dilute the key points with three hours of feedback, then that doesn’t seem useful. Maybe the evaluator should refer for psychotherapy and provide the treating psychologist and/or psychiatrist the report and they can help integrate the results and implement the plan over time.
 
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I structure my assessments by having at least one (sometimes two) session for the clinical interview, one session for testing, then one session for feedback. There might be slight deviations from this approach, but I tend to use this approach 99% of the time. I work for the VA, so I am unsure about what billing practices are on their end, but generally speaking, I am using a 90834 for my feedback sessions if they are about 45 minutes, otherwise I will use a 90832 for shorter ones.
 
My FB sessions are rarely a full hour....usually 25-45min. A 3hr FB session sounds super sketchy. I guess if it were peds, w a lot of behavioral issues/new autism dx, and the session was also used to layout a treatment plan and start w some interventions.....maybe, but otherwise I can't reasonably see how that makes sense.

ps. I don't do autism assessment in my current practice, but that was the only type of case I could think of that would be really involved and the data/recs from the assessment would remotely account for an extended session. Even for a 1:1 head injury case I would want to break up into 1hr sessions bc there is only so much a family will tolerate in a single session.
 
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Heist said:
She is on the insurance panels. If people don't use their insurance then she does the three hour feedback. If they use their insurance then she does one hour feedback.
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Doesn't take 3 hours. What is she doing with all that time?
 
ohiopsychdoc said:
I structure my assessments by having at least one (sometimes two) session for the clinical interview, one session for testing, then one session for feedback. There might be slight deviations from this approach, but I tend to use this approach 99% of the time. I work for the VA, so I am unsure about what billing practices are on their end, but generally speaking, I am using a 90834 for my feedback sessions if they are about 45 minutes, otherwise I will use a 90832 for shorter ones.
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96131/96133 includes for feedback.
 
ohiopsychdoc said:
I structure my assessments by having at least one (sometimes two) session for the clinical interview, one session for testing, then one session for feedback. There might be slight deviations from this approach, but I tend to use this approach 99% of the time. I work for the VA, so I am unsure about what billing practices are on their end, but generally speaking, I am using a 90834 for my feedback sessions if they are about 45 minutes, otherwise I will use a 90832 for shorter ones.
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I've heard of folks using psychotherapy codes for feedback, but I'd be careful to be sure your notes are then sufficient to meet whatever VA, etc., requires of psychotherapy notes (which you may already be doing). Particularly since 96132/96133 specifically include interactive feedback as falling under that code. I don't know if it'd fly with Medicare or private insurance, especially since sometimes you're billing the medical rather than mental health side.
 
AcronymAllergy said:
I've heard of folks using psychotherapy codes for feedback, but I'd be careful to be sure your notes are then sufficient to meet whatever VA, etc., requires of psychotherapy notes (which you may already be doing). Particularly since 96132/96133 specifically include interactive feedback as falling under that code. I don't know if it'd fly with Medicare or private insurance, especially since sometimes you're billing the medical rather than mental health side.
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She never gives out her or her therapists notes. Even with appropriate releases, she refuses. Stat board doesn't care
 
AcronymAllergy said:
I've heard of folks using psychotherapy codes for feedback, but I'd be careful to be sure your notes are then sufficient to meet whatever VA, etc., requires of psychotherapy notes (which you may already be doing). Particularly since 96132/96133 specifically include interactive feedback as falling under that code. I don't know if it'd fly with Medicare or private insurance, especially since sometimes you're billing the medical rather than mental health side.
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Yeah, my feedback notes are structured to include: session location/modality/time frame/C-SSRS last completed/provider info, informed consent, basic demographics, reason for referral, session content, MSE/behavioral observation, risk assessment, summary of session with plan and recommendations, RTC, and DSM-5-TR diagnoses.
 
Therapist4Chnge said:
My FB sessions are rarely a full hour....usually 25-45min. A 3hr FB session sounds super sketchy. I guess if it were peds, w a lot of behavioral issues/new autism dx, and the session was also used to layout a treatment plan and start w some interventions.....maybe, but otherwise I can't reasonably see how that makes sense.

ps. I don't do autism assessment in my current practice, but that was the only type of case I could think of that would be really involved and the data/recs from the assessment would remotely account for an extended session. Even for a 1:1 head injury case I would want to break up into 1hr sessions bc there is only so much a family will tolerate in a single session.
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If it is straight medical then I couldn't think of anything. Back when I tested kids, we used to a lot of LD and academic achievement stuff as well as placement recommendations, particularly for private schools. Certainly, the academic testing and feedback would not be covered by medical insurance. A similar issue might be the case if there were forensic/financial issues.
 
Heist said:
She never gives out her or her therapists notes. Even with appropriate releases, she refuses. Stat board doesn't care
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Wow, that seems...problematic. Even to patients, "just" to other providers, or both?

Then again, three-hour feedback sessions aren't exactly standard practice, either. That's as long as my actual evaluation in some cases.
 
AcronymAllergy said:
Wow, that seems...problematic. Even to patients, "just" to other providers, or both?

Then again, three-hour feedback sessions aren't exactly standard practice, either. That's as long as my actual evaluation in some cases.
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Won't give notes to anyone. Not sure if insurance has requested it. Her evals are ten to twelve hours.
 
I'm skeptical about the board not caring issue, as refusal to share notes is likely a state law violation as well. This would not be consistent with my experience with state boards anywhere I've practiced.
 
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WisNeuro said:
I'm skeptical about the board not caring issue, as refusal to share notes is likely a state law violation as well. This would not be consistent with my experience with state boards anywhere I've practiced.
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I've reported many therapists for this. I even followed up with the board regarding these notes. No notes.
 
Heist said:
Won't give notes to anyone. Not sure if insurance has requested it. Her evals are ten to twelve hours.
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Outsides of forensics, those eval durations definitely also aren't the norm. I'm surprised insurance is regularly reimbursing them. My standard outpatient clinical evals are typically about 4 hours, which is closer to the average; then add in another couple hours for scoring, record review, and report writing. The only time I've ever come close to a 10+ hour eval was back in training with high-stakes psychoeducational evaluations. And even those were usually about 7-8 hours.

I can't see how a provider would justify not sending clinical notes to another clinical provider when presented with a signed release. And it seems a blatant HIPAA violation to not give notes to the patient. I also don't understand why a state board wouldn't find that problematic.
 
Heist said:
I've reported many therapists for this. I even followed up with the board regarding these notes. No notes.
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If that is true, your state is an outlier, if this is the state psych board, anyway. If they are masters level folks, who knows, those boards are all over the place. Also if true, feel free to check your state laws regarding notes (also a violation of federal law in some cases), if there is a statute, you can always threaten legal action. This is something I have never encountered in over a decade of practice.
 
WisNeuro said:
If that is true, your state is an outlier, if this is the state psych board, anyway. If they are masters level folks, who knows, those boards are all over the place. Also if true, feel free to check your state laws regarding notes (also a violation of federal law in some cases), if there is a statute, you can always threaten legal action. This is something I have never encountered in over a decade of practice.
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Many therapists balk at sending notes as many aren't taking notes or their notes are terrible. I'll be lucky if I get ten to twenty per cent of notes from therapists. I'm not going to threaten legal action or complain federally.
 
Heist said:
Many therapists balk at sending notes as many aren't taking notes or their notes are terrible. I'll be lucky if I get ten to twenty per cent of notes from therapists. I'm not going to threaten legal action or complain federally.
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Well, they need to take at least a minimum amount of notes that allows them to bill for services. If that's all they have, that's all you can get. They don't have to, and generally should not, send process notes without a court order.
 
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Heist said:
Many therapists balk at sending notes as many aren't taking notes or their notes are terrible. I'll be lucky if I get ten to twenty per cent of notes from therapists. I'm not going to threaten legal action or complain federally.
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I worked at a community mental health for a couple of years where most of the masters people wouldn’t do there notes. My wife was in billing so she couldn’t bill until these incompetent people got there notes in. So I am. It surprised that you have run into it. It seems like there are clusters of incompetent folks that congregate in certain places which makes sense. I got the heck away from there because I was getting paid the same as them and working three times as much because my patients would actually show up. Since then, I have found that there are some incredibly competent and skilled clinicians out there. They’re just not always easy to find. Also, even though the process of becoming a psychologist is more rigorous than midlevels and this helps to screen out the bad apples, there are still some that we aren’t exactly proud of and what you describe about this one does make me wonder.
 
WisNeuro said:
Well, they need to take at least a minimum amount of notes that allows them to bill for services. If that's all they have, that's all you can get. They don't have to, and generally should not, send process notes without a court order.
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If a patient signs consent for them I should be able to get the notes. I just ask for the last three notes so I know what is going on with the patient as they spend much more time with them than I do. You don't need a court order for notes, just the signed patient permission.
 
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Heist said:
If a patient signs consent for them I should be able to get the notes. I just ask for the last three notes so I know what is going on with the patient as they spend much more time with them than I do. You don't need a court order for notes, just the signed patient permission.
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Therapists need to release progress notes, they should not release process notes without a court order, ROI or not.
 
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