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Free CEU: Clinical Documentation – What You Need and What You Don’t.

“I was taught to keep my notes vague.”

I hear this all the time… I was taught exactly the same thing! I hear this one, too: “If you don’t accept insurance, your notes don’t really matter.” One of my favorite professors, an expert on meditation and expert witness appearances, emphatically told my class, “You never know when your notes could be used against a client, so always keep them short and general.” It sounded good to me… except for the fact that he was wrong… short and general notes are a recipe for disaster from a liability standpoint. (And I have a funny anecdote to share about that professor, but more on that later…).

So many myths float around our profession, and they’re sometimes very dangerous for us and for our clients. Our notes, regardless of whether we’re in private practice or at an agency, are legal documents, and they need to reflect the same accuracy and detail expected of medical professionals. Yes, my previous professor was right about part of it: Our notes can be used in court, and they may be detrimental to a client. That said, they can also be used to protect us in the event of a sentinel incident investigation, like a suicide, or if there’s a complaint filed against our licenses. Our notes can also help our clients receive the care and benefits they need, like short-term/long-term disability or insurance authorizations. We are in a line of work that is inherently unpredictable, and the care we provide can be risky… our notes need to illustrate why we did what we did, at every step of the way.

What’s more, our notes need to consistently establish and illustrate medical necessity, even if we don’t accept insurance. I like to draw upon the medical model to illustrate this point: Imagine a surgeon performing a surgery and failing to keep notes of what she’d done because the patient asked her not to? Imagine if she didn’t keep notes because the patient paid cash instead of using insurance? Imagine if she performed the surgery and there was a complication, and the patient filed a board complaint against the doctor? It’s a real slippery slope. Oftentimes, the only thing standing between us and licensure loss is our records. Additionally, did you know that therapists can even be faced with legal charges like insurance fraud or medical negligence for failure to keep appropriate records? Eek! And double eek when you consider that a medical negligence charge has nothing to do with whether or not a clinician accepted insurance payments!

So, given that I heard these myths too many times, I created a free podcast Continuing Ed course on the subject, called Clinical Documentation: What You Need & What You Don’t approved by the APA, NBCC, NAADAC, CAMFT, and CCAPP. We clinicians didn’t go into this line of, work because we like keeping records, but they’re very important to our clients and to our practices, and this free course is my little way of trying to guide clinicians away from preventable documentation oversights.

And back to the story about my professor: Years later, said professor came to see one of my clinical documentation trainings. When I went to speak with him afterwards, his voice was a little shaky, his face a tad bit pale. He sheepishly said, “Oh my. I had no idea. The student surpasses the master.” I laughed, patted him on the back, and assured him that I’d help him get his notes in order…!


About the author: Elizabeth (Beth) Irias is a Licensed Marriage & Family Therapist with a specialization in Law & Ethics, and the founder of Clearly Clinical, a podcast-based Continuing Ed company approved by the APA, NBCC, NAADAC, CAMFT, and CCAPP. It’s Clearly Clinical’s mission help clinicians learn, grow, and shine by way of high quality, affordable, diverse, and relevant podcast Continuing Education courses. Clearly Clinical donates a portion of proceeds to The Trevor Project in support of suicide prevention services for LGBTQ+ youth, and regularly offers free and low-cost live and online Continuing Education courses. It’s time to shine a new light on Continuing Ed. Please visit to learn more!

date:  May 29, 2019
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Medicaid Expansion and Behavioral Health Across the States

The Affordable Care Act (ACA), also known as Obamacare, provides for expanded Medicaid coverage for low-income Americans. So far, 36 states and the District of Columbia have adopted Medicaid expansion.

Current State of U.S. Medicaid Expansion

ACA offers financial incentives for adopting the Medicaid expansion, but courts have ruled that the decision to expand Medicaid is still up to individual states. There is no deadline, so states that have chosen to increase Medicaid eligibility are at varying stages of program expansion.
Idaho, as of May 2019, is waiting for the federal government to accept the state’s voter-approved plan to expand Medicaid eligibility. If approved, Medicaid coverage for Idaho residents will start in 2020. Earlier this year, however, state lawmakers passed work requirements and other restrictions that may cause delays.

North Carolina is currently debating Medicaid expansion, with Gov. Roy Cooper meeting with healthcare leaders who support the effort. Proponents argue that expanding coverage would increase care opportunities for state residents, add healthcare jobs, and support rural hospitals. A bill introduced in the state House would provide an alternative to Medicaid expansion. This would help close the state’s coverage gap at a lower cost by requiring program participants to work and pay premiums.

Virginia has expanded Medicaid coverage, with enrollment beginning January 1, 2019. Although the state expected about 200,000 people to enroll in the first six months, about 277,000 adults have already enrolled.

How State Decisions Affect Behavioral Health and Addiction Treatment

One concern surrounding Medicaid coverage is the potential for expanded access to behavioral health services. How is Medicaid expansion affecting some states’ behavioral health services?

Idaho’s nine community recovery centers for addiction and mental illness are financially vulnerable. The centers’ request for funding under the Idaho Millennium Fund was not included in Gov. Brad Little’s fiscal 2020 budget recommendation. Little intends to use the fund for the state’s Medicaid expansion. Medicaid expansion could increase access to behavioral health services, but recovery centers may not survive without state funding.

In Virginia, a study by Virginia Commonwealth University (VCU) examined the prevalence of substance use disorder among uninsured Virginians and newly eligible Medicaid members. Researchers found that opioid prescriptions declined among members, and more of them are receiving co-prescriptions for the opioid antagonist naloxone. Virginia is “well prepared” to manage the increased need of addiction treatment services due to Medicaid expansion, says Peter Cunningham, PhD, a professor at VCU School of Medicine’s Department of Health Behavior and Policy.

North Carolina last year received federal approval of a Section 1115 waiver to provide financing for Healthy Opportunities Pilots, a new pilot program to cover evidence-based, non-medical services to target social needs that can affect health. The program addresses housing, transportation, and food insecurities, as well as interpersonal violence and toxic stress.

Prepare for Expanded Behavioral Health Services

Behavioral health and addiction treatment providers may see greater demand in states that expand Medicaid or receive Section 1115 waivers. A comprehensive EHR solution can help you keep up with demand while streamlining services.

Created specifically for behavioral health professionals, BestNotes EHR offers the features you need to improve patient care, increase practice revenue, and reduce staff frustration. Contact us today to learn more about our solutions, or to schedule a free demonstration.

date:  May 28, 2019
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Addiction Treatment Access Increases Under Medicaid Expansion, Study Shows

A new study suggests that Medicaid expansion can give low-income individuals better access to buprenorphine for opioid addiction. One concern about expanding Medicaid under the Affordable Care Act (ACA) is that it will give patients increased access to addicting opioid medications. The new study results, published in Health Affairs, could help alleviate these concerns.

Addiction Treatment and Medicaid Study Findings

West Virginia is at the epicenter of a national opioid crisis, with a 2016 fatal opioid overdose rate of 43.4 per 100,000 population—more than triple the US average.

Researchers looked at claims data from 2014 to 2016 among people enrolled in the West Virginia Medicaid expansion program under the Affordable Care Act. The researchers wanted to examine trends in treatment for opioid use disorder (OUD) in this population. Such patients may have had limited access to OUD treatment before the expansion.

About 5.5 percent of all enrollees included in the study were diagnosed with OUD each year. From 2014 to 2016, the monthly prevalence of OUD diagnoses nearly tripled. About one-third of those patients diagnosed with OUD filled buprenorphine orders in early 2014. This rate increased to more than 75 percent by late 2016.

The mean annual duration of filled buprenorphine increased from 161 days to 185 days in 2014 to 2016. Researchers found that most patients who received buprenorphine also received counseling and drug testing. This aligns with FDA recommendations for medication-assisted treatment for OUD.

State Medicaid Expansion and Addiction Treatment

The new study focused solely on data from West Virginia, since it has experienced some of the most serious consequences of the national opioid crisis. In 2016, the fatal opioid overdose rate in West Virginia was more than three times the national average, at 43.4 per 100,000 people.
As OUD and other addictions persist throughout the nation, other states and researchers are also considering the potential impact of Medicaid expansion.

Researchers writing in the Journal of General Internal Medicine looked at trends in fatal drug overdoses deaths in Arizona, Maine, and New York. These three states had all expanded Medicaid program eligibility before implementation of the ACA. Results show that rates of drug overdose deaths rose less sharply in these states compared with all states that did not expand Medicaid.

A study published in the Journal of Health Economics in 2018 found that “aggregate opioid admissions to specialty treatment facilities increased 18 percent in expansion states, most of which involved outpatient medication-assisted treatment (MAT).” The results also showed that opioid admissions from Medicaid beneficiaries rose 113 percent. These effects were greatest in expansion states with comprehensive MAT coverage.

This year, Virginia became the 33rd state to expand Medicaid, which included expanded access to addiction treatment options. Virginia Commonwealth University examined the prevalence of SUD among uninsured Virginia residents and newly eligible Medicaid members. The university reports that opioid prescriptions have declined among members, but a growing number are receiving co-prescriptions for the opioid antagonist naloxone. This is also part of a statewide effort to curb the opioid crisis.

Addiction Treatment and Behavioral Health EHR Solutions

If you’re a behavioral health provider in a state that has enacted Medicaid expansion, you may be seeing increased demand. BestNotes EHR, created for behavioral health and addiction treatment organizations, can help you streamline your services so you can improve care, track patient outcomes, and increase practice revenue. Contact us today to learn more, and even schedule a free demo.

date:  May 21, 2019
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Three Important Steps to Get Started With Behavioral Health and Addiction Treatment Telehealth

A growing number of companies in various industries now employ remote workers, reducing workplace expenses, expanding opportunities, and even increasing productivity. Behavioral health is no exception to this movement, with the rise of telehealth allowing therapists and other clinicians to see patients remotely.

The growing popularity of telehealth among both patients and providers makes it worthwhile, and even essential, for behavioral health and addiction treatment organizations to adopt.

Making Remote Behavioral Health and Addiction Treatment Telehealth Work

Telehealth is more than just setting up a Skype account. Billing requirements, HIPAA rules, and other aspects of healthcare can make telehealth more complicated than other remote industries.
Here are some steps to help you get started with telehealth in behavioral health and addiction treatment organizations.

1. Hire the right people.

Whether your remote workers are clinicians or administrative staff, it’s important to find individuals best suited for telehealth. “We like to see a history of working autonomously or indications that the applicant is a self-starter,” says Jon Winther, Chief Marketing Officer at BestNotes.

The right qualities may not be immediately obvious, so behavioral health organizations might want to spend more time on candidates when hiring remote workers. Even after hiring, consider a probation period of 3-9 months to “test drive” the relationship. This will not only help you get familiar with each other, but can encourage trust between management, staff, and patients, which is vital element for remote work, including telehealth.

2. Use collaborative tools.

Communication is a major concern among organizations new to telehealth and remote work. Fortunately, numerous free or low-cost solutions can help clinicians, managers, and support staff stay in touch and on-task.

Besides email, other communication solutions include Google Chat and Zoom. Google’s suite of applications, such as Docs and Sheets, allow multiple users to edit or contribute to documents. Trello, Asana, and Slack can help with task management. There are also many different telehealth software and practice management solutions available for behavioral health and addiction treatment organizations.

3. Provide thorough training.

Even providers who support telehealth recognize that it requires different skills than in-person patient interactions. Not only do clinicians need to be trained in the telehealth software, but should also develop appropriate skills. These include:

Understanding when virtual care is appropriate and when in-person care is required
Communicating effectively with virtual patients
Accurately evaluating signs and symptoms for virtual patients
Applying best practices to virtual care.

In 2014, the American Telemedicine Association (ATA) announced an accreditation program for eligible telemedicine providers. Starting in 2017, this telehealth accreditation program has been managed through a partnership with ClearHealth Quality Institute.

Telehealth and other health software providers usually offer training with the purchase of their solutions. For example, the entire implementation process at BestNotes is done with videoconferencing. Staff training is also performed over videoconference, even for in-office employees. When considering and purchasing telehealth solutions, make sure to ask vendors about any training they offer.

Support Your Telehealth Practice With Specialized EHR

BestNotes EHR was developed specifically to serve behavioral health and addiction treatment practices. Whether you’ve already launched your telehealth program or you’re exploring the possibility, BestNotes can help operations stay streamlined and cost-effective.

Contact us today to learn more about how BestNotes EHR can help you improve care, track patient outcomes, and increase practice revenue.

date:  May 17, 2019
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What Are Section 1115 Waivers and How Do They Affect Behavioral Health?

One main goal of the Affordable Care Act (ACA) is increased insurance coverage for low-income Americans. The ACA aimed to achieve this goal partly through the expansion of Medicaid to most U.S. adults at 138 percent of the federal poverty level.

Although there are financial incentives for adopting the Medicaid expansion, the decision is still up to individual states. As of April 2019, 36 states and the District of Columbia have adopted the Medicaid expansion. This leaves 14 states that have not expanded their Medicaid program coverage.

What Are Section 1115 Waivers?

Federal law gives individual states some flexibility in how they implement and operate their Medicaid programs. States may also apply for a Section 1115 waiver, granted by the Centers for Medicare & Medicaid Services.

Section 1115 waivers give states additional leeway to deviate from federal Medicaid guidelines and laws. States also can use the waivers to test different ways to deliver or fund Medicaid services.

Behavioral Health and Section 1115 Waivers

Many people who are currently uninsured and living at or below the federal poverty level also struggle with mental illness, addiction, or other behavioral health issues. Federal law requires all state Medicaid programs to provide some mental health services. Some state Medicaid programs provide beneficiaries with addiction treatment services.
By expanding Medicare coverage, more individuals may gain access to services to help address their behavioral health needs.
Even states that have not formally expanded Medicaid can use Section 1115 waivers to expand coverage to additional low-income residents. The mental-health organization NAMI has officially called on every state to expand Medicaid and apply for Section 1115 waivers to ensure that Medicaid programs provide “adequate mental health services and supports.”

One use for Section 1115 waivers is to improve service systems for behavioral health and addiction treatment. As of September 2017, 12 states had approved Section 1115 Medicaid waivers related to behavioral health.

How Are States Using Section 1115 Waivers?

Under new legislation, the Idaho Department of Health and Welfare has been directed to seek a Section 1115 waiver for multiple changes to the state Medicaid program. If the waivers are not approved by January 1, 2020, then all individuals at or below the federal poverty line will be enrolled in Medicaid.

One change involves adding questions about substance use disorder to the initial Health Assessment to direct beneficiaries to services early. Another change is the use of Medicaid funds directly for inpatient behavioral health and addiction treatment services.

Arizona used a waiver approved in 2016 to better integrate physical and behavioral health, including payment incentives to providers. In Delaware, a waiver allowed the state in 2015 to implement a voluntary program that provides enhanced behavioral health services for certain Medicaid beneficiaries.

Prepare for Expanded Behavioral Health Services

Behavioral health and addiction treatment providers could see an increase in demand in states that have expanded Medicaid coverage or received Section 1115 waivers. Adopting a comprehensive EHR solution can help you keep up with demand while streamlining services.

Created specifically for behavioral health professionals, BestNotes EHR offers the features you need to improve patient care, increase practice revenue, and reduce staff frustration. Contact us today to learn more about our solutions, or to schedule a free demonstration.

date:  May 02, 2019
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