Insurance/advertisement/fee/referral

Question 1

The patient must have “?” for the therapy to be paid by their insurance. If I made up a diagnosis, it would be -

Answer 1

medical necessity

fraud

Question 2

If patient’s insurance company denies coverage when a patient does have a medical necessity (diagnose), I have an ethical obligation to -

Answer 2

to advocate on behalf of client.

Question 3

It is fraud to increase ? of condition to get paid.

Answer 3

severity

Question 4

It is fraud to bill insurance ? when treating them as a couple.

Answer 4

individually

Question 5

It is ? wrong to charge higher fee because patient’s insurance pays lower.

Answer 5

legally and ethically wrong

Question 6

When you are seeing patient under EAP, it is important to discuss limitations such as -

Answer 6

the number of treatment allowed

therapy could be not completely confidential if the focus of therapy is work related.

Question 7

What needs to be on every single advertisement?

Answer 7

My license number and license designation (LCSW)

Question 8

When must I discuss fees with patients?

Answer 8

prior to starting a session

Question 9

When discussing fees with patients, what do I need to include?

Answer 9

methods of payment; frequency of payment; who is responsible for payment (parent/insurance).

Question 10

When raising session fee, what needs to be given to client?

Answer 10

Ample notice - at lease 3 months. (this must be in IC)

Question 11

If a client faces hardship (e.g. lost job) and can’t pay full fee, what do I do ethically?

Answer 11

lower fee during hardship

Question 12

If a client doesn’t pay fee, what am I allowed to do?

Answer 12

send overdue payment to collection agency.

Question 13

When sending to collection agency, what information can I tell them?

Answer 13

the name of the client

and the amount owed

Question 14

If client didn’t pay and moved to a different therapist, what am I still obligated to do?

Answer 14

release the record

Question 15

Bartering for services is only acceptable if-

Answer 15

if it is a common practice among the professionals in that community
AND initiated by client.

Question 16

It is unethical to allow client to continue therapy when -

Answer 16

cannot pay and have a huge amount of debt.

Question 17

It is acceptable to terminate client for nonpayment, if -

Answer 17

client is NOT in crisis.

Question 18

What do I do FIRST if client cannot pay?

Answer 18

discuss payment plan with client

Question 19

When is it appropriate to refer client out?

1. Client seeks advice outside of-

Answer 19

1. outside of scope of practice (medication/psychiatry)

Question 20

When is it appropriate to refer client out?

2. Terminating client -

Answer 20

2. prematurely (e.g. moving/closing practice)

Question 21

When is it appropriate to refer client out?

3. Client is not making progress even after -

Answer 21

3. changing course of treatment and trying everything.

Question 22

When receiving referral, what am I NOT allowed to do?

Answer 22

giving reward for referral