As a mental health pro, your main focus is to help people rather than being overwhelmed by paperwork. However, there are times when it is crucial to focus on paperwork, especially when it comes to meeting the requirements set by the Centers for Medicare and Medicaid Services (CMS) for documenting psychotherapy sessions. Maintaining proper documentation ensures compliance, […]
SOAP notes are a widely adopted method of progress note documentation used by mental health professionals to write down and organize information clearly, concisely, and systematically. The SOAP method offers a structured framework to document therapy sessions, track client progress, and support clinical decision-making. This method fosters a holistic view of the client while focusing on specific […]
What strategies do you have in mind to engage your clients and improve your occupational therapy practice? As an occupational therapist, setting meaningful goals for your clients is essential. However, covering all aspects, such as physical, cognitive, self-care, and work-related goals, can be overwhelming. In this blog, we will provide you with a step-by-step guide […]
You won’t believe the transformation your SOAP notes will undergo when you start working with kids! It’s time to take your pediatric SOAP notes to the next level. Get ready to learn how to make your notes to fit the needs of your little clients, including what to include, examples, templates, and expert tips. We’ll […]
You've likely heard the term "patient confidentiality" before, but do you know what it means for you as a mental health professional? In your role, you're privy to extremely sensitive information about your clients' lives, so maintaining confidentiality is crucial. But it's also complex. There are exceptions. In this article, we'll cover the ins and […]
Imagine entering your office and discovering a voicemail from a prospective client eager to schedule an initial session with you! This client heard about your therapy practice from a friend and is ready to dive in. But wait, they are concerned about leaving personal details on a recording. As therapists, our voicemails are often the […]
Mental health professionals face relentless administrative burdens. Documentation shouldn’t be one of them. This article compares Mentalyc and Autonotes, two prominent AI-powered documentation solutions, to help you choose the platform that best elevates your practice. While Autonotes offers a basic option, Mentalyc goes beyond, empowering you to deliver exceptional care with greater efficiency and accuracy. […]
What’s this sudden “AI” buzz? Artificial Intelligence (AI) isn't new but its recent advancements and growing accessibility have sparked a surge of interest, particularly in the competitive mental health landscape. Unlike before, AI today isn't just theoretical. With increased processing power, sophisticated algorithms, and vast datasets, AI applications are now practical and demonstrably valuable. This […]
How to Write DAP Notes There are a variety of methods therapists can use to write progress notes. With various ways to document client sessions, mental health professionals may have difficulty choosing which documentation format to use. DAP notes have three clearly defined sections, which help therapists cover the necessary information in their therapy progress […]
Writing progress notes may be a dreaded part of your day if you’re a mental health professional. You may wonder what a progress note should look like or what template you should use. When you are writing therapy progress notes, there isn’t one template that is recommended. Many insurance companies require you to state what […]
You’re not alone if you’re a therapist who feels utterly lost when writing a new client’s biopsychosocial (BPS) assessment. Writing this report is more time-consuming and arguably more emotionally intimidating than other types of clinical documentation. Progress notes like GIRP or SOAP notes tend to be shorter and capture smaller time frames. Whereas BPS assessments are longer, more comprehensive in […]
Imagine you’ve had a long day, and your practice is full. You have a day’s worth of progress notes to write but do not know where to start. Maybe you’re struggling to remember what happened in your first session this morning or have fallen behind and feel overwhelmed. You may do something else entirely because […]
Note-taking can be a tedious process for many mental health professionals. It can be time-consuming and knowing what information goes into your notes to protect against insurance audits and prove medical necessity can be overwhelming. If you’re writing progress notes, the challenges, and limitations associated with neurodiversity can make documenting therapy intakes and psychotherapy sessions difficult. Holding attention and space […]
Are you tired of feeling intimidated by the maze of complex CPT codes associated with psychiatry? Don't worry, you're not alone! Understanding psychiatry and CPT codes can be demanding. However, with our exclusive cheat sheet, you'll have everything you need to confidently navigate psychiatry's most common behavioral health codes, from diagnostic and evaluation codes to […]
Mental health clinicians use various therapeutic modalities to help treat their clients. Some therapists are rigid in their practice, and others are more laid-back. Many times, mental health professionals gravitate towards modalities and methods of treatment that match their style. Despite the modalities used, the therapeutic relationship is one of the most essential elements of […]
Mental health outcome measures are valuable instruments used to assess the progress of individuals' mental well-being. These measures effectively capture a range of metrics, including various aspects of client functioning, symptomatology, and treatment experiences. Such assessments capture baseline data at the commencement of services, as well as progress documented as support continues. What Are We […]
Description Current Procedural Terminology (CPT) Code 90846 is used within mental and behavioral health services to denote a specific type of therapeutic interaction. This code is important in the coding and billing process as it helps categorize mental health professionals' services. CPT code 90846 is used for 50-minute face-to-face or telehealth family psychotherapy sessions when […]
The GAD-7 is a user-friendly, self-administered questionnaire for screening and measuring generalized anxiety disorder severity. The Generalized Anxiety Disorder 7-Item Questionnaire (GAD-7) The GAD-7 score is obtained by adding the scores for each of the 7 questions (total points) (range: 0-21) Scoring & Interpretation Now that you’ve completed the GAD-7 questionnaire, it’s important to understand […]
We've all been there. Your heart starts racing as you think about having to give a presentation in front of the class. Or maybe the idea of making small talk at a party makes you break out in a cold sweat! Social anxiety is something most people can relate to on some level. But for […]
You’ve probably heard about CPT codes, but how familiar are you with the nitty-gritty details? If you’re a mental health professional interested in couples and family therapy, it’s time to get up close and personal with CPT code 90847. When used correctly, this code is the key to unlocking insurance reimbursement for couples and family […]
CPT Code 90838 Description CPT Code 90838 refers to individual psychotherapy sessions that last 60 minutes, with the patient physically present for the session. This code is essential to the billing and documentation process for mental health professionals, including psychologists, clinical social workers, psychiatrists, psychotherapists, and counselors – any mental health professional providing and paying […]
CPT Code 90832 Description CPT code 90832 is a code used in the mental and behavioral health field, and it reflects the provision of an individual 30-minute psychotherapy session with the patient physically present. This code is part of a broader set of CPT codes designed to categorize and standardize mental health treatments for billing […]
First let's see What is a CPT Code? A CPT code, or Current Procedural Terminology code, is a medical code used to describe medical, surgical, and diagnostic services and procedures. CPT codes are part of a coding system created by the American Medical Association (AMA). These codes, used by healthcare providers, insurance companies, and accreditation […]
As helping professionals, our primary aim is to gain a thorough understanding of those who seek our guidance. There exist various respectful avenues for cultivating knowledge about an individual’s experiences and circumstances, whether through brief check-ins or more extended discussions. Often, a carefully organized interview allows for in-depth learning about how someone functions and behaves […]
