Counseling Today, Private Practice in Counseling

Maintaining client files

Robert J. Walsh and Norman C. Dasenbrook November 1, 2007

Q: I am all set to start my private practice after attending your workshop in North Carolina. I have two questions. First, I’ve searched the ACA Ethical Standards Casebook, sixth edition, and your book, The Complete Guide to Private Practice for Licensed Mental Health Professionals, and I am unable to find “the number of years” a records custodian should hold on to client files in the event that the primary clinician is incapacitated or dies. Also, what is the number of years a counselor should hold on to client files after termination of a private practice?

A: We applaud your diligence in researching this question before beginning your private practice. We spoke to Larry Freeman and Martha McIntosh, the ethics gurus at the American Counseling Association. The ACA Code of Ethics does not specify the number of years records should be maintained in the event of the counselor’s death, incapacitation or termination of practice. Instead, the code of ethics states (in Standard B.6.g.), “Counselors store records following termination of services to ensure reasonable future access, maintain records in accordance with state and federal statutes governing records, and dispose of client records and other sensitive materials in a manner that protects client confidentiality.”  

The standard was written this way because requirements might vary from state to state. Therefore, your first step is to consult with the North Carolina Counseling Association or your state’s mental health counselors division. (For a listing of ACA state branches and links to their websites, visit the ACA website at www.counseling.org and click on the box labeled “Divisions/Regions/Branches” on the left-hand side of the page.) This is a great example of why it is imperative — though not necessarily cheap — for counselors to belong to their professional organizations at the state, division and national level.

As with other practice issues, informed counselors should be familiar with their state practice laws, federal statutes (HIPAA and others) and the ACA Code of Ethics. This is one reason we do not include a statement about the specific number of years to maintain files in our book. Another is the possible variance based on discipline (counseling, social work, marriage and family therapy and psychology). However, a good benchmark is to maintain records seven years for adults and 10 years for children after treatment or the closing of a practice.

Concerns have surfaced regarding possible changes in Current Procedural Terminology (CPT) codes used by counseling practitioners in agencies and mental health practices to file insurance claims. Some ACA members have forwarded information saying that an organization is offering a class with continuing education units to help practitioners learn all the CPT changes. The cost for this course is $239.

One member sent the following e-mail:

“(I have a) question (that) has to do with new CPT codes for mental health in 2008. I’ve not seen any info on this matter. I received an e-mail from an LCSW friend. I will forward you information (about the class teaching the new codes). Perhaps you can address these topics in your column. Others may or may not be aware.”

We researched these concerns and can provide the following information.

American Behavioral, a mental health managed care company, says it knows of no changes to the CPT coding developed and copyrighted by the American Medical Association (AMA). American Behavioral’s Network Development Coordinator, Rachael Millazzo, checked with her coding department and assured us that the CPT codes for mental health and psychotherapy will remain the same for the foreseeable future.

In addition, a review of the AMA website (https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp) shows no changes in the CPT coding for psychotherapy. Further, Donna Zappia, director of Netsource Billing, a major billing service, states there are no changes in CPT codes by Medicare or any of the managed care or insurance companies. We recommend thoroughly researching any course or class on CPT code changes before signing up.

On another topic, ACA members have been asking why Blue Cross Blue Shield has reduced its reimbursement rate by 60 to 75 cents. Although only a small amount, counselors are concerned this might be the start of a trend.

Asked about this, Donna Zappia of Netsource Billing explained that Blue Cross Blue Shield and some other insurance companies tie their reimbursement rates to Medicare reimbursement rates. An adjustment to these rates by Congress took effect in June and is reflected across the industry by various managed care and insurance companies.

We don’t think this is a trend, but rather a policy being followed by the industry. No further cuts are expected. However, we will continue to monitor changes in reimbursement rates by managed care and insurance companies.

Yes, this is the last, last reminder about using your National Provider Identifier (NPI) number. We have updated counselors in this column for the past several months about the need to obtain and use your NPI number. There were several deadline extensions, but December 2007 was it! All managed care and insurance companies, as well as Medicare, will start returning claims filed without this number.

The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of a standard unique identifier for health care providers. The National Plan and Provider Enumeration System collects identifying information on health care providers and assigns each a unique NPI.

Additional information is available on the NPPES website: https://nppes.cms.hhs.gov/NPPES/Welcome.do. Application/update forms can be downloaded at https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart.

We hope to see you in Hawaii at the ACA Conference & Expo, where we will be presenting our preconference Learning Institute, “Starting, Maintaining and Expanding a Successful Private Practice” on March 27. Onsite private practice consultation will be available. Also come visit us in the exhibitor center and preview our book, The Complete Guide to Private Practice for Licensed Mental Health Professionals (www.counselingprivatepractice.com).

ACA members can e-mail their questions to Robert J. Walsh and Norman C. Dasenbrook at walshgasp@aol.com and access a series of “Private Practice Pointers” on the ACA website at www.counseling.org.

Letters to the editor: ct@counseling.org