Abundant Practice Podcast: Episode #661 Summary
Title: Avoiding Clawbacks - Private Practice Notes 101
Host: Allison Puryear
Guest: Dr. Tiana Kelly
Release Date: June 25, 2025
Introduction
In Episode #661 of the Abundant Practice Podcast, host Allison Puryear sits down with Dr. Tiana Kelly to delve into the critical topic of documentation in private practice, specifically focusing on avoiding clawbacks. Clawbacks, often stemming from documentation errors, pose significant financial risks to therapists, especially those in group practices. This episode provides invaluable insights into best practices for note-taking, the differences in documentation requirements based on payment models, common mistakes, and the emerging role of AI in clinical documentation.
The Importance of Effective Documentation
Allison opens the discussion by highlighting recent trends where therapists face clawbacks from insurance companies due to inadequate documentation. She emphasizes the necessity of meticulous note-taking to ensure compliance and avoid financial penalties.
Allison Puryear [04:16]: “We really want to make sure that documentation is as buttoned up as it can be. Even though none of us are like, 'gosh, I wish I could do more of that,' so what would you say are like the basics of what we absolutely need to have in every single note?”
Dr. Kelly responds by outlining the foundational elements that should be present in every therapeutic note to satisfy both clinical needs and insurance requirements.
Dr. Tiana Kelly [04:16]: “We want to have some data on our observations… what are the interventions we’re using and how are those interventions connected to the goal work. They want to see evidence that the goals are being worked on within the notes.”
Basics of Effective Note-Taking
Dr. Kelly elaborates on the essential components of therapeutic notes, emphasizing the importance of observations, interventions, goal alignment, and planning. She underscores the need for notes to reflect genuine clinical work rather than being mere checkboxes for compliance.
Dr. Tiana Kelly [04:16]: “What are the interventions we're using and how are those interventions connected to the goal work… What's the plan between sessions?”
Documentation for Insurance-Based vs. Private-Pay Practices
The conversation transitions to the differences in documentation requirements between insurance-based and private-pay practices. Allison expresses concern over whether private-pay clinicians might neglect thorough documentation due to the absence of insurance audits.
Allison Puryear [09:29]: “What is the difference in documentation from an ethics perspective for private pay clinicians versus clinicians who take insurance?”
Dr. Kelly stresses that regardless of the payment model, thorough documentation is crucial not only for compliance but also for providing the best possible care and protecting oneself legally.
Dr. Tiana Kelly [10:01]: “If something were to happen, if it wasn't written, you don't have a leg to stand on. So that documentation is for you to make sure that you're protecting yourself in the event that something catastrophic or even something minor were to happen.”
Common Documentation Mistakes and Their Risks
Allison and Dr. Kelly identify and discuss common pitfalls in clinical documentation, including:
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Timeliness: Delaying note completion can lead to errors and increase the risk of clawbacks.
Dr. Tiana Kelly [12:05]: “Timeliness sticks out time and time again as one of the biggest errors…”
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Miscoding: Incorrect billing codes due to oversight or haste can result in financial discrepancies.
Allison Puryear [18:13]: “The coding errors and the proofreading problems could lead to clawbacks as the primary risk involved there.”
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Proofreading Errors: Simple mistakes, such as misspelling a client's name, can undermine the professionalism and accuracy of records.
Dr. Tiana Kelly [13:50]: “It’s super important to just at the very minimum give that quick glance over to make sure like do you at least have the client's name spelled right?”
The discussion highlights the severe implications of these mistakes, including financial losses that could jeopardize the viability of group practices.
Allison Puryear [16:35]: “I've worked with group practice owners who had $30,000 clawbacks… that's a ton of money that the practice no longer has and that they might not be able to stay open.”
Mitigating Documentation Risks
To address these challenges, Dr. Kelly recommends strategies such as:
- Adhering to Timelines: Completing notes promptly to maintain accuracy and reduce backlog.
- Accurate Coding: Being meticulous with billing codes to reflect the actual session details.
- Regular Proofreading: Implementing a routine check to catch and correct errors before finalizing notes.
Dr. Tiana Kelly [18:38]: “Like letting quality swiftness through documentation… could really have some detrimental outcomes.”
The Role of AI in Clinical Documentation
The podcast also touches on the controversial topic of using AI for generating clinical notes. Dr. Kelly expresses caution regarding AI integration, citing concerns over data security, accuracy, and the lack of regulatory frameworks.
Dr. Tiana Kelly [25:20]: “Until we know more, it's probably not the best to be integrating in. And if you have had access to training, then, you know, then it's okay.”
Allison echoes these sentiments, emphasizing the importance of maintaining integrity and oversight when utilizing AI tools to ensure that notes accurately reflect the therapeutic sessions.
Allison Puryear [26:08]: “Making sure that it talks about the time you start and end, making sure that it talks about medical necessity… you still need to make sure that what they say happened in session happened in session.”
Actionable Insights and Recommendations
In concluding the episode, both Allison and Dr. Kelly offer practical advice for therapists aiming to enhance their documentation practices:
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Consult Insurance Manuals: Although tedious, thoroughly reading insurance documentation helps create a clear blueprint for required note elements.
Dr. Tiana Kelly [24:01]: “If you kind of sit down with those manuals, you will be able to create that blueprint for yourself.”
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Trust Clinical Training: Leveraging clinical intuition and training to determine what information is essential for client care and compliance.
Dr. Tiana Kelly [21:54]: “Trust your clinical gut… include it if it needs to be in the note.”
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Implement Structured Templates: Developing standardized note templates can streamline the documentation process and ensure consistency.
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Continuous Education: Engaging in ongoing training and supervision to stay updated on best practices and compliance requirements.
Allison Puryear [28:33]: “It was what was most helpful to me and that is reading the insurance manuals.”
Conclusion
Episode #661 of the Abundant Practice Podcast offers a comprehensive exploration of the intricacies involved in clinical documentation within private practice. By addressing the fundamentals of effective note-taking, identifying common errors, and providing strategies to mitigate risks, Allison Puryear and Dr. Tiana Kelly equip therapists with the knowledge needed to maintain compliant and efficient documentation practices. The episode underscores that thorough and timely documentation is not only a regulatory necessity but also a cornerstone of quality client care and the sustainability of private practices.
Resources Mentioned:
- AbundancePracticeBuilding.com – Free private practice checklist, worksheets, and more.
- Powbox.com – HIPAA-compliant email solutions.
- TherapyNotes.com – Electronic health record (EHR) platform for therapists.
- PrivatePracticeByDesign.com – Additional support and resources offered by Dr. Tiana Kelly.
Notable Quotes:
- Allison Puryear [04:16]: “What are the interventions we're using and how are those interventions connected to the goal work… What's the plan between sessions?”
- Dr. Tiana Kelly [10:01]: “This documentation is for you to make sure that you're protecting yourself in the event that something catastrophic or even something minor were to happen.”
- Allison Puryear [16:35]: “I've worked with group practice owners who had $30,000 clawbacks… that's a ton of money that the practice no longer has and that they might not be able to stay open.”
- Dr. Tiana Kelly [25:20]: “Until we know more, it's probably not the best to be integrating in [AI].”
Connect with Dr. Tiana Kelly:
For more insights and support on building a sustainable and joyful private practice, visit privatepracticebydesign.com.