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Medicaid Compliant Documentation

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19 comments

  • Heather Lee

    HI, I'm so sorry this happened to you. I just took a training on documentation and many of the things that were covered (and mandated by medicare audit) are not incorporated in Simple Practice. It's really scary, b/c I assumed that Simple Practice would ensure compliance! The trainers name is Beth Rontal, LICSW. 

     

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  • Jorge W. Dionisio

    Hi

    The purpose of medicaid is not to get someone in trouble. It is simply to help therapists maximize their productivity and understand the requirements. I have been audited also and there were some changes I had to make.

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  • Kristyn Roe

    I am new to Simple Practice and to Medicaid. The issue of Medicaid's very specific documentation requirements is a major concern for me. I was surprised to not see Medicaid compliant templates offered. Let's ask for those!

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  • Mary Jean Carpenter

    Agreed, this is a huge gap in services that I was hoping this system provided.The EHR program that I had before ensured compliance if form was completed correctly (I don't know if I would  have switched over had I known). Let's create the forms and find a way to "share" with each other.

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  • Rhonda L. Underwood

    Yes we need the patient's name on every page. That's common sense and an area that Simple Practice needs to fix immediately. An area in the heading would be a good place for them to add the location of service. 

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  • Patrick Wood

    Does SimplePractice have anything to say about this ????

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  • Gillian

    Hi Patrick, SimplePractice offers full customization on your Note and Form templates. We recommend adjusting your Note and Form templates to include the fields required by insurance payers, and reach out to insurance payers individually for clarification on their requirements. Rhonda, we're working on updating the print layout of progress notes to help make documentation easier to understand and more readable when responding to an audit.

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  • Patrick Wood

    Gillian,

    I don't think the input note template is the issue. I think the printed report is the issue. Medicaid guidelines mandate that every page of a progress note have the date of service, client name, and page numbers (e.g. Page 1 of 2).  Users of Simple Practice are not able to modify the format or fields of the printed report.

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  • Gillian

    Hi Patrick, thanks for clarifying - we're working on updating our print Progress Note layout, and welcome your feedback on our Ideas board here: https://simplepractice.uservoice.com/forums/918553/suggestions/36553009

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  • Danielle Mansfield

    Wow that is scary and agree with the updates needed for state mandated documentation, especially the name, date of service, and page number.

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  • Gillian

    Hi Danielle, I'm happy to share that our updates to Progress Note print layouts have been completed, and all exported/printed Progress notes include pagination and the client's name on each page, as well as the Date of Service in a more readable format. 

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  • Kristyn Roe

    Thank you Gillian and the SP development team! I am grateful for all efforts SP makes to help therapists be medicaid compliant. It is already very difficult to serve the underserved with all medicaid requires, so any support on the documentation end is very much appreciated!

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  • Cherie J. McGahee MSW, LCSW

    Did you have the exact session time documented in your notes? I just went through an audit and because the time on the note was generated by the scheduled time they are asking for me to pay back everything. I am beside myself about this. Is this something Simple Practice is aware of? Have others had this issue?

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  • Locke Curfman

    Cherie,

    My documentation was like yours, using the system generated time for each session. The problem I have is that I don’t know if I was penalized for that because the audit department has refused to provide me those details. I recently appealed my audit and I am waiting for their decision. I may know more then. Crazy.

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  • Cherie J. McGahee MSW, LCSW

    I'm sorry you are dealing with that. Keep us updated and I will do the same so we can be in compliance from now on. I just recently appealed mine as well. 

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  • Ruth Trowbridge, MA, LPC

    I was considering getting recredentialed with Medicaid now that I am in private practice, but your comments have given me pause! Anyone having success and willing to recommend Medicaid for me?  

     

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  • Anita Barnes

    I am  just getting started in my practice and I am using Simple Practice as well.  One issue I see is that as Medicaid Providers we need a way to get an actual signature (not just a checkbox).  I can't find a way on the forms I am creating to get the system to insert and actual online signature requirement besides the checkbox method.  I probably am missing this in the platform can anyone shed light on this issue?

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  • Katharine Petzold

    I am new to Medicaid and am interested in the answer to these questions re: signatures, etc. Thanks!

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  • Ruth

    Hi Everyone, thank you all for alerting us to this issue! Until recently, our alternative workflow of customizing Progress Note and Intake Form Templates to include information like a client's Medicaid Number and the exact start and stop time of their appointment held up in audits. We really appreciate you sharing your experiences with us, we hear you and want to make sure you're getting paid for services rendered. I'm sorry to be responding so late to some of your comments. I've relayed your concerns to our Product Team and they're currently looking into how to best address the documentation requirements mentioned in this thread. I'll let you know of any updates I hear from them, but in the meantime, continue to customize your Progress Note and Intake Form Templates to include information Medicaid requires that's missing from our default documentation. Go to your Settings > Notes & Forms, select each template that you frequently use to edit them and add fields for appointment start and stop times, as well as the client's Medicaid Number. All documents in your client's Medical Record should have the client's name on each page, the page count, the client's date of birth and the clinician's information. If the eSignature provided by our system isn't meeting Medicaid requirements, you can print the documents and add wet signatures. Our eSignatures hold up legally, but if this isn't your experience when submitting to Medicaid audits, please let us know. Thank you again!

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