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"letter policy"



  • Barbara Wilhelm

    Hi Julie,

    This is a dilemma I have faced as well. It can get overwhelming and can help to set clear policies with clients. The most common problems for me are those wanting short term disability, accommodations or FMLA paperwork. They typically need this right away so a 6 month policy seems like it would be a problem for many. Often they have already started time off and have a deadline of a few weeks for the initial paperwork. It seems reasonable to require at least 2 visits before filling out disability paperwork, if there is a deadline this will require early follow up appointments. I explain that I have to do my normal assessment in the first session and any additional assessment information needed on the forms can take place with the second session. This is because I have had many people come just to get the paperwork and then do not return (of course they come back in a panic when they realize it has to be updated).  I have found it also helps to curtail the number and frequency of requests if you charge a fee for doing extra paperwork, explaining that it takes away from billiable appointment time and I still need to be compensated for that time. If they balk at this, I recommend they have a physician complete it if possible, as they have nursing/administrative staff who can do it for them. 

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  • Teresa Bair

    That sounds like a good process, Barbara, and similar to my own. As a physician, though, I'll tell you that even doctors with a team of nursing and administrative staff usually complete disability/FMLA forms during uncompensated time. Most of us are only paid based on time spent seeing patients, and given a few hours of weekly administrative time. The rest of our work is unpaid (addressing lab results, filling out PAs, ordering refills, answering portal communications, etc), and it's a lot! I know all of us have our own versions of this, though.

    One of my jobs is providing primary care to patients at an outpatient county mental health facility, so this issue comes up a lot for me. If patients are seeking disability or other documents for a mental health condition, but are actively seeing a counselor and/or psych prescriber for all of their mental health care, MH should complete the documents. I can't reasonably know all their previous visit dates, anticipated plans of care, or projected treatment schedules since I'm not the one providing that care. If I am the one managing their MH or other disabling condition, I schedule a separate appt to go through the whole form/letter requirements with them. Unless there are extenuating circumstances, I require them to establish care with a new patient appt first. I usually complete the paperwork or write their letter at the end of my day, after seeing my 15-18 patients (the lower end for PCPs). I have templates for most letters, so most of those are pretty quick, and make for an easy and focused visit and note. Disability forms, court and eviction-related letters, etc can take a lot of time. The patients can usually pick up their documents the morning after our appt, though the clinic has a 7 day policy for patient paperwork requests.

    The clinic doesn't charge extra for documents, though they do charge for the extra office visit. I can't seem to charge extra for paperwork or other care coordination at my own practice, because folks who aren't able to work tend to be broke, and I'm not good at business. But I think it's very reasonable to charge for your additional time. Depending on your fee structure, perhaps you could even schedule an extra long visit, discuss the content during the first half, and use the rest to complete the paperwork?

    Hopefully some of this information is helpful.


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  • Teresa Bair

    Oh! I also tell them to complete any patient portion before the visit. For FMLA, the employer has to complete a portion first as well. And if they're requesting a complicated letter, and they are mentally able to, I'll ask them to write out an example letter of what they're asking for. I may or may not be able to use the text directly, but I always find it helpful.

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